1. Diet and Health Issues of Sweden By: Candice Carlson 10/10/11 Nutrition 3420, 2011

2. Overview Background Traditional Dietary Practices Dietary Analysis Results Special Occasions Traditional Health Care Practices Diet and Health Issues Communication

3. Background Information on Sweden Capital: Stockholm Scandinavian countries include: Sweden, Norway, Denmark, Finland, and Iceland. Fourth Largest Country in Europe Swedishs diet is one of the worlds most innovative. – Simple and hearty. IKEA, 2007

4. Background Vikings (800-1050 a.d.) – Embarked on raids – Invaded lands(British Isles, France) – Teas from France, honey cakes form Germany, and sauces and soups from France Yellow=generosity. Blue=truth, loyalty. Notaker, 2009

5. Timeline 12,000 B.C.- Reindeer hunted in Scandinavia. 9000 B.C.-Elk hunted 4000 B.C.-Stone Age, introduction of agriculture and animal husbandry. 1800 B.C.-Bronze Age, a lot of fishing and seal hunting. 1-400 a.d.- High quality kitchenware and tableware pottery made. Notaker, 2009

6. Timeline 800-1000 a.d.-Viking Age – Preserved meat and fish, porridge, gruels, and curds are dietary staples. 1000-1100 - Christian Laws established – Can not consume horse meat 1538- Ostkaka (Cheesecake) was brought up for the first time in Sweden. 1600-1700-Strong alcohol more common Notaker, 2009

7. Timeline 1650- First Swedish cookbook printed. 1710-1720- First coffee house. 1800-1850- Coffee is a daily drink. 1903- The first Vegetarian Society in Sweden was founded. 1973- First McDonalds opened in Sweden. 2000- Opened a cookbook museum. Notaker, 2009

8. Dala Horse History Created by woodcutters and soldiers. Men spent time away from family. – Carved little horses for children. In 1716, King Charles XII declared war. – Winter, lack of food and warmth – Soldiers traded these for food. Known for armies survival. Used as decorations, trucks, house signs, city letterhead. Popular souvenir, Swedish handicraft. Unofficial symbol of Sweden. Ross, 2008

9. Traditional Dietary Practices 3 meals a day Staple food: potatoes, wheat, rye, barley, and oats Fish, lamb, beef, pork, veal, chicken, eggs, dairy products (cream, cheese), preserved meats (sausage, ham, bacon) Knäckebröd – Hard bread – Eaten at every meal Jacob & Ashkenazi, 2007

10. Typical dishes Herring Dishes: fried, fermented, marinated, pickled. Salmon dishes Crayfish Meatballs Vegetable dishes: stuffed cabbage, creamed cauliflower, potato, anchovy casserole. Sweets: baked apples, dried fruit cream, cinnamon rolls, Lacy Meringue cake, sweet Easter bun with whipped cream and marzipan. Jacob & Ashkenazi, 2007

11. Herring Specialty – Feeds Swedes in abundance – Large part of export economy Baltic Herring: Staple of Swedish diet – Easy to catch, large in numbers – Preserve in salt or ferment – Year round delicacy – High in nutrients and fatty acids – Requires 80 g (3 oz) of salted herring to get necessary protein. Ross, 2008 Proctor & Roland, 2009

12. Herring Fishing for herring – Autumn and spring Once caught, if not served fresh its gutted and cured in brine – Stored in large barrels for months Ready to be eaten – Soaked in water or milk to remove excess salt Served raw, cooked or pickled – Also can be grilled, fried, smoked, baked Ross, 2008

13. Surströmming Sour herring – Delicacy in Northern Sweden – Acquired taste (fermented herring) Fish are caught in the Spring – Fermented in tins for 6 months – Time gases build up and the tins bulge into the size of a soccer ball. Sold on Surströmming Premiere – 3 rd Thursday in August – Sold for 2 to 3 weeks until supplies run out – Traditionally eat when first leaves fall from trees Moss, 2008 Proctor & Roland, 2009

14. Surströmming When the tins open the scent releases – Restaurants wont open on premises because of smell. – Traditionally eaten outdoors – Served in square shaped bread (tunnbröd) with boiled potatoes, chopped onions, sour cream and milk or beer (aquavit) to drink Aquavit – Water of life – liquor – Distillation of potatoes Ross, 2008 Proctor & Reland, 2009

15. Swedish Delicacies Swedish MeatballsJanssons Frestelse Swedish casserole made with potatoes, onions, bread crumbs, butter, cream, and anchovies Served with boiled potatoes, gravy, and lingonberry jam IKEA, 2007

16. Traditional Dietary Practices Smörgåsbord: buffet of hot and cold dishes (fish, meat, vegetables, salad) Stage One: Salted fish Stage Two: All other fish Stage Three: cold cuts of ham, sausage, liver paste Stage Four: Hot dishes Stage Five: Dessert Notaker, 2009 Kittler & Sucher, 2008

17. Etiquette Fork in left hand, knife in right hand Only bread is eaten with hands Sandwiches are eaten with fork and knife Pass dishes to left If not eating, hands are placed on the table resting on the edge. Wine is appreciated as a gift for the hostess Kittler & Sucher, 2008

18. Family Meal Hot meal eaten at home in the company of family members. – High regard for family meals Most Scandinavians eat most of their meals at home (50%). Eating at home is common during weekends – Friday, Saturday, and Sunday nights – Meal eaten around kitchen or dining room table – 19-30% eat at sofa, coffee table, or armchair Notaker, 2009

19. Family Meal Eating with friends isnt very common. – Young eat more with friends then elderly Important element in building family unit – Women feel it maintains cohesiveness in the unit – Organize the day in a way that makes a family meal possible. Notaker, 2009

20. Breakfast Limit to coffee or juice Few eat traditional porridge Main grain product is bread – Butter, margarine, vegetable spread, jams, cheese spreads, caviar. Sausage, boiled or cured ham and liver paste. Many eat packaged cereal and yogurt Eggs are rare, typically served on Sunday Eaten at home on an individual basis. Notaker, 2009

21. Coffee Swedes drink a lot of coffee. Worlds second highest drinkers of coffee. Coffee break- mid morning and mid afternoon – Coffee or tea with cinnamon bun Jacob & Ashkenazi, 2007

22. Lunch Many Swedes eat out for lunch. Foreign food are popular – Mexican, Thai, Chinese, American fast food. Pizzerias are common – Swedish style – Seafood and salad on top. Jacob & Ashkenazi, 2008 Notaker, 2009

23. Dinner Swedes have two hot meals a day Hot meal consists of: – Main dish (meat) – Staple (Potatoes, rice, pasta) – Second staple (bread) – Side dish (vegetables) – Hot and cold sauces and condiments Kittler & Sucher, 2009 Notaker, 2009

24. Proper Meal Consists of meat, potatoes, and one or more vegetable side dishes and sauces 1.Main Dish (center)- meat, fish, or vegetable 2.Staple- consists of potatoes, rice, pasta 3.Side dish- Vegetable (Raw or cooked) 4.Accompaniments (hot and cold sauces) 5.Bread Proper meal made from scratch Notaker, 2009

25. Current common dishes 1)Falun sausage (boiled) -Specialty -beef, pork, veal 2) Spaghetti with meat sauce 3)Pizza Usually drink milk, beer, or wine Kittler & Sucher, 2008

27. Diet Analysis Name: LucyHeight: 5 ft. 7 in.Weight 130 lbs, active Breakfast: 1 pancake 2 oz. sausage 1 T. Jam 1 T. butter 1 slice bread Lunch: 3 oz. salmon 1 cup mashed potatoes 1.5 cup salad 2 T. salad dressing 1 slice bread Dinner 4 pieces pickled herring 7 oz. cabbage 1.5 c. mashed potatoes 1 slice bread Snacks 1 cinnamon bun 1 slice bread 0.5 cup cucumbers Drinks Coffe e, milk, pear juice, apple juice Diet Analysis, 2009

28. Diet Analysis Results My Pyramid Goal*Actual% Goal Grains9.0 oz. eq.tips6.5 oz. eq.71.7% Vegetables3.5 cup eq.tips3.7 cup eq.105.2% Fruits2.0 cup eq.tips1.6 cup eq.82.2% Dairy3.0 cup eq.tips2 cup eq.66.7% Protein Foods 6.5 oz. eq.tips9.2 oz. eq.140.8% Empty Calories 410.0694.3169.3% Diet Analysis, 2009 Results are based on a 2479 calorie diet

29. Macronutrient Ranges Carbs 46%, Protein 14%, Fat 40% Diet Analysis, 2009

30. Dietary Analysis Fat and Cholesterol Results Saturated fat: 15% Monounsaturated fat: 11% Polyunsaturated fat: 5% Unspecified 8% Cholesterol: 229 mg Dietary Analysis, 2009

31. Dietary Analysis Results Vitamins and Minerals Vitamins: Vitamin A (89%), Vitamin E (40%), and Folate (59%) were deficient Minerals: Iron (60%), Magnesium (94%), Potassium (77%), and Zinc (88%) were deficient Omega 6 was short at 92%. Sodium was excessive: 396% Consumed 2576 calories based on a 2479 calorie diet Diet Analysis, 2009

32. Dietary Analysis Results Vitamins and Minerals Diet Analysis, 2009

33. Sources of Nutrients Carbohydrates and fiber: bread, potatoes Protein: salmon Fat: sausage, milk, butter SUFA: milk, butter, cinnamon bun MUFA: sausage, herring PUFA: salad dressing, pancakes Vitamin C: pear juice B Vitamins: bread, potatoes, herring, salmon, milk Sodium: sausage, potatoes, salad dressing, cabbage, herring cucumbers, bread Diet Analysis, 2009

34. Fruits and Vegetables Swedish are close to meeting daily recommended intake of fruits and vegetables. Highest consumption in Sweden Vegetables-39 times a month 1/3 eat vegetables two times daily Fruit-37 times a month Consumption due to eating habits – Hot meals are accompanied by salad Diet high in fat and sugar Simunaneimi, Anderson, Nydahl, 2009 Notaker, 2009

35. Solutions Eat more fruits and vegetables Eat more whole wheat bread More fish Boil or bake potatoes Reduce sugar, fat, salt, Reduce fatty potato, fatty dairy and fatty meat products Notaker, 2009

36. Easter Easter is one of the biggest Swedish festivals. Eggs top the menu. – Eggs served in every form. – Accompanied with pickled herring. Children dress up as Easter witches. IKEA, 2007

37. Walpurgis Night April 30 th Celebrate arrival of Spring – Big Bonfires – Male voice choirs One of the Worlds most choral countries. Feast is followed. – Janssons Temptation – Served with crisp bread, cheese, beer, Swedish vodka IKEA, 2007

38. Midsummer End of June Evening before celebration – Girls pick 7 flowers and dream of the man to be hers. Dance Games Food – Fish, boiled new potatoes, wild strawberries are common for Sweden – Matjes herring, pickled herring, new potatoes cooked in dill, chives, soured cream, crisp bread, cheese, beer, Swedish Vodka IKEA, 2007

39. Saint Lucia December 13 th Christian girl who died for her faith (Lucia) Eldest daughter – Head wreath, candles, long white robe Serve parents in bed – St. Lucia buns (Lussekatter) and coffee while in bed. Lucia choir show is followed. Schools and businesses closed IKEA, 2007

41. Christmas Eve Father Christmas comes on December 24 th. Traditional Dinner (Smörgåsbord) – Consists of 20 to 30 dishes – Centerpiece is Christmas ham. – Pickled herring, lutfisk, meatballs, chipolatas, potatoes, meatballs, peas, bread, cheese, beer, and Swedish Vodka. – Desserts are rice pudding, saffron buns, ginger biscuits, nuts, dried fruit. Presents are brought by Jultomten (Tomten). IKEA, 2007 Kittler & Sucher, 2008

42. Health Practices and Beliefs Information is limited Sweden massage (therapeutic) – found in the United States – Technique using 5 key strokes. – May promote healing, enhance circulation, and provide a sense of relaxation. Swedes are enthusiastic about tradition – Many are Christian – Evangelical Lutheran church Kittler & Sucher, 2008

43. Obesity and Weight Issues Increasing amount of people overweight Problem since the 1960s Overweight children – 25% overweight – 3% obese Women working outside of the home – More fast food – Child-care Providers – Greater risk for heart disease, diabetes, cancer, stroke. Garerno, Lenner, & Strandvik, 2007 Lagiou, Sandin, Weiderpass, Lagiou, Mucci, Trichopoulous & Adami,2007 Notaker 2009 Wallstrom, Bjartell, Gullburg, Olsson & Wirfalt, 2009

44. Counseling Low context – Analytical Comfortable with silence Maintain direct eye contact Handshakes when being greeted Avoid discussion of illness until needed. – Sickness may be considered a weakness (physical, moral). Kittler & Sucher, 2008

45. Summary Swedens diet is simple and hearty. Staple foods consist of potatoes, wheat, rye, fish (herring), beef, pork, dairy products. Delicacies include; Herring (Baltic), Swedish Meatballs, Janssons Frestelse, and Surströmming. Diet is high in fat and sugar with high fruit and vegetable intake. Enthusiastic about tradition. Special Occasions include: Easter, Walpurgis Night, Midsummer, Saint Lucia, and Christmas Eve. Obesity and weight issues are prevalent in Sweden.

46. References Diet Analysis Plus 9.0 Online, 9th Edition (2009). Belmont: Wadsworth. Garerno, M., Lenner, R., & Strandvik, B. (2007). Swedish pre-school children eat too much junk food and sucrose. Acta Paediatrica, 96(2), 266-272. IKEA. (2007). Ikeas real Swedish food book. Inter IKEA Systems. Jacob, J., & Ashkenazi, M. (2009). The world cookbook for students. (Vol. 5, pp. 28- 32). Wesport: Greenwood Press. Kittler, P. G., & Sucher, K. P. (2008). In Food and culture: fifth edition (pp. 194-199). Belmont:Thomson Wadsworth. Lagiou, P., Sandin, S., Weiderpass, E., Lagiou, A., Mucci, L., Trichopoulous D., & Adami H. (2007). Low carbohydrate-high protein diet and mortality in a cohort of swedish women. Journal of Internal Medicine, 261(4), 366-374.

47. References Notaker, H. (2009). Food culture in scandinavia. (p. 81, 109, 151, 181). Westport: Greenwood Press. Proctor, J., & Roland, N. (2009). The rough guide to sweden. (5 ed.). Ross, Z. (2008). Travellers sweden. (2 ed.). Italy: Thomas Cook Publishing. Simunaniemi, A., Andersson, A., & Nydahl, M. (2009). Fruit and vegetable consumption close to recommendations. A partly web based nationwide dietary survey in swedish adults. Food and Nutrition Research, 53, 1-9. Wallstrom, P., Bjartell, A., Gullberg, B., Olsson, H., & Wirfalt, E. (2009). A prospective swedish study on body size, body composition, diabetes, and prostate cancer risk. British Journal of Cancer, 100(11), 1799-1805.