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Water is essential for survival, but one in three individuals worldwide (2.2 billion people) lacks access to safe drinking water. Water intake requirements largely reflect water turnover (WT), the water used by the body each day. We investigated the determinants of human WT in 5604 people from the ages of 8 days to 96 years from 23 countries using isotope-tracking ( 2 H) methods. Age, body size, and composition were significantly associated with WT, as were physical activity, athletic status, pregnancy, socioeconomic status, and environmental characteristics (latitude, altitude, air temperature, and humidity). People who lived in countries with a low human development index (HDI) had higher WT than people in high-HDI countries. On the basis of this extensive dataset, we provide equations to predict human WT in relation to anthropometric, economic, and environmental factors.

Source at https://vkm.no/. In 2006, VKM published “A comprehensive assessment of fish and other seafood in the Norwegian diet”. The assessment supported the recommendation from Norwegian Health authorities to eat more fish both for dinner and on sandwiches. In an update of the assessment in 2014 VKM concluded that “the benefits from fish consumption clearly outweigh the negligible risk presented by current levels of contaminants and other undesirable substances in fish”. Because of new knowledge available, the Norwegian Food Safety Authority requested a new benefit and risk assessment of fish in the Norwegian diet in 2019. In the assignment, they asked VKM to answer the following questions: Which health consequences will it have for the Norwegian population if they: Continue with the same fish consumption levels as of today Increase the consumption of fish to match the recommendations given by the Norwegian Directorate of Health

In 2019, the Nordic network on dietary surveys compared results regarding 24 h recalls, if the method was used in a systematic Nordic set up. A standardized central food list for 7 days was entered into national nutrients calculation systems and the intakes of individual food groups and nutrients on each day and as a daily average of the 7 days were compared. Results were presented at an online workshop on November 20th, 2020. In addition to the country specific presentations of the analysis, each country also gave a presentation on the latest national dietary survey. Despite standardized input, there were many differences in the results. The presentations on national dietary surveys showed differences and similarities of conducting dietary surveys and elucidated a lot of the common challenges researchers face. Many topics could be further elucidated on future network meetings.

Request from the Norwegian Food Safety Authority: Following a report from the National Nutrition Council calling for actions to secure adequate iodine intake in the population, the Norwegian Food Safety Authority requested the Norwegian Scientific Committee for Food and Environment (VKM) to conduct a benefit- and risk assessment of iodization of household salt and industrialised salt in bread. VKM addressed the request: VKM appointed a project group consisting of members of the Panel on Nutrition, Dietetic Products, Novel Food and Allergy and Panel on Contaminants to answer the request. The Panel on Nutrition, Dietetic Products, Novel Food and Allergy has reviewed and revised drafts prepared by the project group and finally approved the benefit- and risk assessment This benefit and risk assessment is based on 1) established knowledge about health consequences from severe iodine deficiency, 2) systematic literature review of the evidence for health consequences of mild to moderate iodine deficiency, 3) literature review of studies on adverse health effects from excessive iodine intakes to re-evaluate existing tolerable upper intake levels (ULs), 4) evaluation of estimated iodine intake levels in different population groups in Norway compared to established dietary reference values, specifically estimated average requirement (EAR) and UL, and finally 5) an estimation of the effect of different scenarios of increasing iodization levels in household salt and salt in bread on iodine intake levels in different population groups compared to the established dietary reference values EAR and UL. For the purpose of this benefit and risk assessment of iodization in household salt and salt in bread, risk may be understood as risk of adverse health effects related to too high or too low iodine intakes. Benefit may be understood as reduction or avoidance of adverse health effects related to too high or too low iodine intakes. For iodine, this is a challenging maneuver, as the gap between too low and too high intakes is narrow. The project group conducted two systematic literature reviews. One was performed to evaluate the evidence for the impact of mild- to moderate iodine deficiency on neurodevelopment, thyroid function and birth outcomes, the other to evaluate the evidence for adverse health effects from excessive iodine intake to possibly re-evaluate the existing tolerable upper intake levels. Current evidence for adverse health effects of iodine deficiency: Severe iodine deficiency resulting in hypothyroidism during foetal life, infancy, or early childhood may lead to permanent intellectual disability. Severe maternal iodine deficiency in pregnancy may also result in miscarriages, preterm delivery, stillbirth, and congenital abnormalities. These effects are due to low levels of thyroid hormones affecting the developing tissues. The health effects of severe iodine deficiency are well established, but for mild to moderate deficiency the effects are less known. After screening of more than 15 000 titles and abstracts and quality assessment of 131 full text scientific papers, 36 publications were included for the grading of evidence for consequences of mild to moderate iodine deficiency. We used the criteria proposed by the World Cancer Research Fund for grading of evidence. Based on our systematic literature review, the evidence for adverse effects from mild to moderate iodine deficiency and neurodevelopment was judged to meet the criteria for limited suggestive. Limited suggestive means that the evidence is too limited to permit a probable or convincing causal judgement but shows a generally consistent direction of effect. It was further concluded that there is limited (no conclusion) evidence to support that mild to moderate iodine deficiency causes thyroid dysfunction or has negative effects on birth outcomes. Limited (no conclusion) means that the evidence is so limited that no firm conclusion can be made. Established reference values for iodine requirement: Several competent bodies have established dietary reference values for iodine. We have based this benefit and risk assessment on estimated average requirements (abbreviated EAR or AR) from the Nordic Nutrition Recommendations (2012) for adults, and from the Institute of Medicine (2001) for adolescents and children. Estimated average requirement is an iodine intake that is estimated to meet the requirement of half the healthy individuals in the population. The iodine intake is considered to be adequate if 97.5% of a population has a habitual intake above the estimated average requirement. Re-evaluation of tolerable upper intake levels: As the evidence for health effects of excessive iodine intakes is far less comprehensive than for iodine deficiency, we did not aim at evaluating the literature for excess intakes with the same weight of evidence tools as for deficiency. We have only evaluated whether recent literature is in line with the existing tolerable upper intake levels or if it supports that tolerable upper intake levels should be changed. Generally, UL is the maximum level of total chronic daily intake judged to be unlikely to pose a risk of adverse health effects, and in the case of iodine the UL for adults is the maximum daily intake where changes in TSH are unlikely to occur (SCF, 2002). After screening more than 2500 titles and abstracts, five studies fulfilled the inclusion criteria and were found relevant and included for evaluation of existing ULs. The existing ULs from the Scientific Committee on Food from 2001 is maintained. However, according to findings in new studies, the lowest-observed-adverse-effect levels (LOAEL) for excessive iodine intake may be lower than previously assumed, and the uncertainty factor inherent in the established ULs is reduced from three to 1.3 for adults. The findings also indicate a reduced LOAEL for the existing ULs in children. Changes in thyroid stimulating hormone (TSH) without changes in thyroid hormones (T3 or T4), that is subclinical hypothyroidism, are observed in one randomised controlled dose-response study and four cross-sectional studies in children at iodine intakes close to the ULs. Subclinical hypothyroidism is not considered to be harmful, but may progress into overt hypothyroidism. Iodine intake in Norwegian population groups and implications of salt iodization: Iodine intakes in adults are higher in men than in women and increase with increasing age for both sexes. Women of childbearing age and 13-year-old girls have the lowest estimated iodine intakes. 26% of the women of childbearing age have intakes below the estimated average requirement of 100 µg/day, and 38% of the 13-year-old girls have intakes below the estimated average requirement of 73 µg/day. The estimated iodine intakes in the 5th percentile of women of childbearing age and 13-year-olds is 70 and 38 µg/day, respectively. All adults and 13-, 9- and 4- year-olds have individual intakes below the tolerable upper intake levels. The estimates for 2-year-olds show that 9% have intakes below the estimated average requirement, and 8% have intakes above the tolerable upper intake level. The estimated iodine intake in the 95th percentile is 215 µg/day, slightly above the tolerable upper intake level of 200 µg/day. The estimates for non-breastfed 1-year-olds show that 8% have intakes below the estimated average requirement, and 18% have intakes above the tolerable upper intake level. The estimated iodine intake in the 95th percentile for this group is 259 µg/day. We present 12 scenario tables combining three scenarios (household salt alone, salt in bread alone and both household salt and salt in bread) with four iodization levels (15, 20, 25 and 50 mg iodine per kg salt). The percentages of the population groups with intakes above the estimated average requirement increases with increasing iodization levels, but so does the percentages with intakes above tolerable upper intake levels for some groups of the population. The scenarios that seem to elevate iodine intakes in women of childbearing age and 13-yearolds up to adequate intakes, are iodization up to 15 or 20 mg iodine per kg salt, including iodization of salt in bread. Above these iodization levels, no increased benefit would be expected in women of childbearing age and 13-year-olds. For 1- and 2-year-olds all scenarios lead to an increase in the proportion of toddlers with estimated intakes above the tolerable upper intake level. Benefit- and risk characterisation of iodization of household salt and industrialised salt in bread: Low estimated iodine intakes in adolescents (13-year-olds) and women of childbearing age (18-45 years) cannot be sufficiently corrected by the proposed increased iodization levels of salt and/or bread without imposing high iodine intakes in 1- and 2-year-old children. VKM assumes that the women of childbearing age and 13-year-olds will benefit from increased iodization levels in salt and bread. This will also benefit other groups that, for various reasons, have few iodine-rich sources in their diet, e.g., people who do not eat lean fish or consume milk or other dairy products. The risk imposed on the youngest age groups is a higher proportion of the 1- and 2-year-olds with iodine intakes above the tolerable upper intake level. Based on the scientific evidence and the data presented in this benefit and risk assessment it cannot be concluded that a specific iodization level benefits all age and gender groups without posing increased risk of harm to others or that the benefits in one population group outweighs the risks in others, or that the benefits in one group outweigh the risks in others. It should be noted that recommendations for nutrients are set to secure adequate growth, development, maintenance of health, and to reduce the risk of chronic illnesses. Thus, iodine intakes below EAR or above UL will decrease the possibilities of achieving the beneficial effects of adequate intake. Current iodine intake in certain population groups is worryingly low, and trend studies indicate that consumption of milk and dairy products in Norway, the most significant iodine sources in the diet, is declining, especially among young women. Several studies show that especially adolescents and women of childbearing age have insufficient iodine intakes, which may leave some at risk of severe iodine deficiency. There are, however, to our knowledge, no data on the prevalence of severe iodine deficiency in Norway. In other words, we do not know how many, if any, there are who have clinical consequences of inadequate iodine intakes. The scenarios that seem to elevate iodine intakes in women of childbearing age and 13-year olds (the groups at highest risk of low intakes) to adequate levels are iodization up to 15 or 20 mg iodine per kg salt, including iodization of salt in bread. Above these iodization levels, no increased benefit would be expected in women of childbearing age and 13-year-olds whereas several population groups will be at risk of exceeding UL, especially in 1- and 2-year-olds. The WHO recommends salt as a vehicle for correcting iodine deficiency in a population, followed by a close monitoring of the iodization program.

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We study the algebraic combinatorics of monomial degenerations of Plücker forms which is governed by matching fields in the sense of Sturmfels and Zelevinsky. We provide a necessary condition for a matching field to yield a SAGBI basis of the Plücker algebra for 3-planes in n-space. When the ideal associated to the matching field is quadratically generated this condition is both necessary and sufficient. Finally, we describe a family of matching fields, called 2-block diagonal, whose ideals are quadratically generated. These matching fields produce a new family of toric degenerations of Gr(3,n).Background: Disease-related malnutrition is a challenge among hospitalized patients. Despite guidelines and recommendations for prevention and treatment, the condition continues to be prevalent. The MyFood system is a recently developed decision support system to prevent and treat disease-related malnutrition. Objective: To investigate the possible implementation of the MyFood system in clinical practice, the aims of the study were (1) to identify current practice, routines, barriers, and facilitators of nutritional care; (2) to identify potential barriers and facilitators for the use of MyFood; and (3) to identify the key aspects of an implementation plan. Methods: A qualitative study was performed among nurses, physicians, registered dietitians, and middle managers in 2 departments in a university hospital in Norway. Focus group discussions and semistructured interviews were used to collect data. The Consolidated Framework for Implementation Research (CFIR) was used to create the interview guide and analyze the results. The transcripts were analyzed using a thematic analysis. Results: A total of 27 health care professionals participated in the interviews and focus groups, including nurses (n=20), physicians (n=2), registered dietitians (n=2), and middle managers (n=3). The data were analyzed within 22 of the 39 CFIR constructs. Using the 5 CFIR domains as themes, we obtained the following results: (1) Intervention characteristics: MyFood was perceived to have a relative advantage of being more trustworthy, systematic, and motivational and providing increased awareness of nutritional treatment compared with the current practice. Its lack of communication with the existing digital systems was perceived as a potential barrier; (2) Outer settings: patients from different cultural backgrounds with language barriers and of older age were potential barriers for the use of the MyFood system; (3) Inner settings: no culture for specific routines or systems related to nutritional care existed in the departments. However, tension for change regarding screening for malnutrition risk, monitoring and nutritional treatment was highlighted in all categories of interviewees; (4) Characteristics of the individuals: positive attitudes toward MyFood were present among the majority of the interviewees, and they expressed self-efficacy toward the perceived use of MyFood; (5) Process: providing sufficient information to everyone in the department was highlighted as key to the success of the implementation. The involvement of opinion leaders, implementation leaders, and champions was also suggested for the implementation plan. Conclusions: This study identified several challenges in the nutritional care of hospitalized patients at risk of malnutrition and deviations from recommendations and guidelines. The MyFood system was perceived as being more precise, trustworthy, and motivational than the current practice. However, several potential barriers were identified. The assessment of the current situation and the identification of perceived barriers and facilitators will be used in planning an implementation and effect study, including the creation of an implementation plan.

The Norwegian Scientific Committee for Food and Environment (Vitenskapskomiteen for mat og miljø, VKM) has, at the request of the Norwegian Food Safety Authority (Mattilsynet, NFSA), evaluated the intake of fluoride in the diet, together with intake of fluoride from dental hygiene and caries prevention products. VKM has also evaluated suggested maximum limits for fluoride in food supplements at 0.5, 1, 5 and 7 mg/day in relation to established tolerable upper intake levels (ULs). The former maximum limit for fluoride of 0.5 mg/day in food supplements was repealed 30 May 2017. Fluorine is a gaseous halogen which occurs naturally only in anionic form as fluoride (F- ). Fluorides are ubiquitous in air, water and the lithosphere. Fluoride is found naturally in all water sources. The highest levels are found in groundwater. Surface water usually has lower concentrations of fluoride than groundwater, most often under 0.5 mg/L. Major dietary fluoride sources are water and tea. An important non-dietary source is dental hygiene products such as toothpaste and tablets for caries prevention. There is no fluoridation of drinking water or salt in Norway. Fluoride is not an essential nutrient. Caries is not a fluoride deficiency disease. However, because of the beneficial effects for caries prevention, an adequate intake (AI) of 0.05 mg per kg body weight per day has been set for fluoride by the European Food Safety Authority (EFSA). Readily soluble fluorides (sodium- and potassium fluoride) are rapidly and almost completely absorbed by passive diffusion in the stomach and the small intestine. Absorption is influenced by acidity and concomitant food intake. Absorbed fluoride is rapidly distributed in blood plasma, but is retained only in calcified tissues, that are bones and teeth. Consequently, 99% of the total fluoride content of the body is found in bone and teeth. Absorbed fluoride which is not deposited in calcified tissues is excreted almost exclusively via the kidneys. Whereas skeletal bone and dentine accumulate fluoride throughout life, enamel of teeth incorporate fluoride only at the time of tooth formation. Fluoride substitutes for hydroxyl groups in the apatite, increasing the resistance to caries. In permanent teeth enamel maturation is completed at the age of seven to eight years, except in the third molars. Posteruptive fluoride uptake by enamel occurs only in the outer layer and depends on local oral fluoride levels. A linear relationship between fluoride exposure and caries resistance has been demonstrated. Over the years, the view has shifted from systemic fluoride being most effective for caries prevention to local oral exposure being most important. Acute toxic effects may be provoked by fluoride, and deaths have been reported after intake of very large doses from fluoride tablets. The main adverse outcomes from intake of excess doses of fluoride over time, are enamel fluorosis in children up to eight years of age, and bone fluorosis in older children and adults. Dental fluorosis causing mottled teeth is largely a cosmetic effect, whereas bone fluorosis causes stiff joints and a greater tendency to fractures. Tolerable upper intake levels (UL) for fluoride have been set by the American Institute of Medicine (IOM) and by the European Food Safety Authority (EFSA). In this report, we relate estimated fluoride intakes to the upper level set by EFSA. Intakes of the main dietary fluoride sources, water and tea, in different age groups were obtained from Norwegian dietary surveys. High fluoride intakes were estimated by applying the 95 percentile of fluoride concentrations in water obtained from 2001 fluoride analyses from Norwegian waterworks in the period between 2010 and 2018 and in tea obtained from a Polish study to the daily volume consumed. Fluoride intakes from recommended use of dental hygiene and caries prevention products were then added, plus a small fixed value for undescribed sources. The estimated 95 percentile fluoride exposure calculated this way was compared to the upper level, and scenarios with additional fluoride supplementation of 0.5, 1, 5 or 7 mg/day were developed. The estimated 95-percentile of fluoride exposure from water, tea and dental hygiene products alone (before fluoride from the suggested food supplement doses at 0.5, 1, and 7 mg/day were added) was found to exceed the upper level for 2-year old children and for adults. VKM concludes that all the suggested food supplement doses considered will cause the tolerable upper intake level to be exceeded in all age groups, except for the supplement doses of 0.5 in 9- and 13-year olds and 1 mg/day in 9 year olds. VKM emphasises that the current assessment of maximum limits for fluoride in food supplements is merely based on published reports concerning upper levels from the IOM (USA, 2001), Scientific Committee on Food (EU, 2003), Expert Group on Vitamins and Minerals (UK, 2003) and Nordic Nutrition Recommendations (Nordic Countries, 2012). VKM has not conducted any review of the literature for the current opinion, as this was outside the scope of the terms of reference from the NFSA.

The objective of the present research was to investigate associations of dispositional and momentary self-control and the presence of other individuals consuming SSBs with the consumption frequency of sugar-sweetened beverages (SSBs) in a multi-country pilot study. We conducted an Ambulatory Assessment in which 75 university students (52 females) from four study sites carried smartphones and received prompts six times a day in their everyday environments to capture information regarding momentary self-control and the presence of other individuals consuming SSBs. Multilevel models revealed a statistically significant negative association between dispositional self-control and SSB consumption. Moreover, having more self-control than usual was only beneficial in regard to lower SSB consumption frequency, when other individuals consuming SSBs were not present but not when they were present. The findings support the hypothesis that self-control is an important factor regarding SSB consumption. This early evidence highlights self-control as a candidate to design interventions to promote healthier drinking through improved self-control.

The Norwegian Scientific Committee for Food and Environment (Vitenskapskomiteen for mat og miljø, VKM) has, at the request of the Norwegian Food Safety Authority (Mattilsynet, NFSA), evaluated the intake of fluoride in the diet, together with intake of fluoride from dental hygiene and caries prevention products. VKM has also evaluated suggested maximum limits for fluoride in food supplements at 0.5, 1, 5 and 7 mg/day in relation to established tolerable upper intake levels (ULs). The former maximum limit for fluoride of 0.5 mg/day in food supplements was repealed 30 May 2017. Fluorine is a gaseous halogen which occurs naturally only in anionic form as fluoride (F-). Fluorides are ubiquitous in air, water and the lithosphere. Fluoride is found naturally in all water sources. The highest levels are found in groundwater. Surface water usually has lower concentrations of fluoride than groundwater, most often under 0.5 mg/L. Major dietary fluoride sources are water and tea. An important non-dietary source is dental hygiene products such as toothpaste and tablets for caries prevention. There is no fluoridation of drinking water or salt in Norway. Fluoride is not an essential nutrient. Caries is not a fluoride deficiency disease. However, because of the beneficial effects for caries prevention, an adequate intake (AI) of 0.05 mg per kg body weight per day has been set for fluoride by the European Food Safety Authority (EFSA). Readily soluble fluorides (sodium- and potassium fluoride) are rapidly and almost completely absorbed by passive diffusion in the stomach and the small intestine. Absorption is influenced by acidity and concomitant food intake. Absorbed fluoride is rapidly distributed in blood plasma, but is retained only in calcified tissues, that are bones and teeth. Consequently, 99% of the total fluoride content of the body is found in bone and teeth. Absorbed fluoride which is not deposited in calcified tissues is excreted almost exclusively via the kidneys. Whereas skeletal bone and dentine accumulate fluoride throughout life, enamel of teeth incorporate fluoride only at the time of tooth formation. Fluoride substitutes for hydroxyl groups in the apatite, increasing the resistance to caries. In permanent teeth enamel maturation is completed at the age of seven to eight years, except in the third molars. Posteruptive fluoride uptake by enamel occurs only in the outer layer and depends on local oral fluoride levels. A linear relationship between fluoride exposure and caries resistance has been demonstrated. Over the years, the view has shifted from systemic fluoride being most effective for caries prevention to local oral exposure being most important. Acute toxic effects may be provoked by fluoride, and deaths have been reported after intake of very large doses from fluoride tablets. The main adverse outcomes from intake of excess doses of fluoride over time, are enamel fluorosis in children up to eight years of age, and bone fluorosis in older children and adults. Dental fluorosis causing mottled teeth is largely a cosmetic effect, whereas bone fluorosis causes stiff joints and a greater tendency to fractures. Tolerable upper intake levels (UL) for fluoride have been set by the American Institute of Medicine (IOM) and by the European Food Safety Authority (EFSA). In this report, we relate estimated fluoride intakes to the upper level set by EFSA. Intakes of the main dietary fluoride sources, water and tea, in different age groups were obtained from Norwegian dietary surveys. High fluoride intakes were estimated by applying the 95 percentile of fluoride concentrations in water obtained from 2001 fluoride analyses from Norwegian waterworks in the period between 2010 and 2018 and in tea obtained from a Polish study to the daily volume consumed. Fluoride intakes from recommended use of dental hygiene and caries prevention products were then added, plus a small fixed value for undescribed sources. The estimated 95 percentile fluoride exposure calculated this way was compared to the upper level, and scenarios with additional fluoride supplementation of 0.5, 1, 5 or 7 mg/day were developed. The estimated 95-percentile of fluoride exposure from water, tea and dental hygiene products alone (before fluoride from the suggested food supplement doses at 0.5, 1, and 7 mg/day were added) was found to exceed the upper level for 2-year old children and for adults. VKM concludes that all the suggested food supplement doses considered will cause the tolerable upper intake level to be exceeded in all age groups, except for the supplement doses of 0.5 in 9- and 13-year olds and 1 mg/day in 9 year olds. VKM emphasises that the current assessment of maximum limits for fluoride in food supplements is merely based on published reports concerning upper levels from the IOM (USA, 2001), Scientific Committee on Food (EU, 2003), Expert Group on Vitamins and Minerals (UK, 2003) and Nordic Nutrition Recommendations (Nordic Countries, 2012). VKM has not conducted any review of the literature for the current opinion, as this was outside the scope of the terms of reference from the NFSA. Vitenskapskomiteen for mat og miljø, VKM, har beregnet inntaket av fluorid fra kosten og inntak av fluorid fra kariesforebyggende tannpleieprodukter, på forespørsel fra Mattilsynet. VKM har videre vurdert hvorvidt et inntak av fluorid fra kosttilskudd på henholdsvis 0,5, 1, 5 eller 7 mg/dag i tillegg til inntak fra kost og tannpleieprodukter vil kunne føre til overskridelser av etablerte tolerable øvre inntaksnivåer (UL) for fluorid. Tidligere maksimumsgrense for fluorid i kosttilskudd var 0,5 mg/dag. Denne maksimumsgrensen ble opphevet 30. mai 2017. Fluor er et halogen som naturlig kun forekommer i anionisk form som fluorid (F-). Fluorider finnes i luft, vann og litosfæren. Fluorid finnes naturlig i alle vannkilder. De høyeste nivåene finnes i grunnvann. Overflatevann har vanligvis lavere fluoridkonsentrasjoner enn grunnvann, oftest under 0,5 mg/L. De viktigste kildene til fluorid i kosten er vann og te. En annen viktig fluoridkilde er kariesforebyggende tannpleieprodukter, som fluortabletter og tannpasta. Det er ikke tilsatt fluorid til hverken drikkevann eller salt i Norge. Fluorid er ikke et essensielt næringsstoff, og karies forårsakes ikke av fluoridmangel. På grunn av at fluorid virker forebyggende på utviklingen av karies, har imidlertid European Food Safety Authority (EFSA) foreslått et adekvat inntak (AI) på 0,05 mg fluorid per kg kroppsvekt per dag. Lettløselige fluorider (natrium- og kaliumfluorid) absorberes raskt og nesten fullstendig ved passiv diffusjon i magen og tynntarmen. Absorbsjonen påvirkes av surhetsnivå og samtidig inntak av mat. Absorbert fluor transporteres raskt i blodplasma, men lagres kun i kalsifisert vev som bein og tenner. Derfor finnes 99 prosent av det totale fluorinnholdet i kroppen i bein og tenner. Absorbert fluor som ikke lagres i kalsifisert vev, skilles nesten utelukkende ut via nyrene. Mens skjelettbein og tannbein (dentin) akkumulerer fluorid gjennom hele livet, bygges fluorid inn i tannemaljen bare under selve tanndannelsen. Fluorid erstatter hydroksylgrupper i apatitt, og øker motstanden mot karies. Permanent tannemalje er ferdig utviklet ved syv til åtte års alder, unntatt i de bakerste jekslene. Opptak av fluorid i tannemaljen etter tannens frambrudd forekommer kun i ytre lag og er avhengig av lokalt fluoridnivå i munnen. Forholdet mellom fluorideksponering og kariesmotstand er vist å være lineært. Mens man tidligere anså at systemisk fluoridbehandling var mest effektiv i forebygging av karies, anser man i dag lokal fluorid i munnen som viktigst. Fluorid kan utløse akutte toksiske effekter, og det har blitt rapportert om dødsfall etter inntak av svært høye doser fra fluoridtabletter. De viktigste negative helseeffektene fra langvarig forhøyet inntak av fluorid er fluorose i tannemaljen hos barn opptil åtte år, og beinfluorose hos eldre barn og voksne. Dental fluorose som gir flekkete tenner, er i hovedsak en kosmetisk effekt, mens beinfluorose gir stive ledd og kan gi økt tendens til beinbrudd. Både Institute of Medicine i USA og EFSA i EU har fastsatt tolerable øvre inntaksnivåer (UL) for fluorid. I denne rapporten vurderer vi de estimerte inntakene av fluorid opp mot UL fastsatt av EFSA. Data for inntak av de viktigste fluoridkildene i kosten, vann og te, ble for denne rapporten hentet fra nasjonale kostholdsundersøkelser for ulike aldersgrupper i den norske befolkningen. I estimatene er 95 persentilen for fluoridkonsentrasjoner basert på 2001 vannanalyser fra norske vannverk i perioden 2010-2018 og te fra en studie fra Polen fra 2008. Deretter er inntak av fluorid fra anbefalt mengde kariesforebyggende tannpleieprodukter lagt til, samt en liten fast verdi for andre uspesifiserte kilder. Det estimerte inntaket av fluorid i 95 persentilen for fluorideksponering er sammenlignet med UL, og scenarier med ytterligere doser fluorid fra kosttilskudd på 0,5, 1, 5 eller 7 mg/dag er vurdert. Estimatene for fluorideksponering i 95 persentilen fra vann, te og tannpleieprodukter alene viser et fluoridinntak som overstiger UL hos toårige barn og hos voksne (før fluoriddoser på 0,5, 1, 5 eller 7 mg/dag fra kosttilskudd ble lagt til). VKM konkluderer med at alle de foreslåtte dosene for fluorid i kosttilskudd (0,5, 1, 5 og 7 mg/dag) vil føre til at UL overskrides i alle aldersgrupper, bortsett fra dosene på 0,5 for 9- og 13- åringer, og 1 mg/dag for 9-åringer. VKM presiserer at denne vurderingen av maksimumsgrenser for fluorid i kosttilskudd er basert på publiserte rapporter om øvre inntaksnivåer fra Institute of Medicine (USA, 2000) og EFSA (EU, 2005). Ettersom mandatet i bestillingen fra Mattilsynet var å vurdere inntaket av fluorid basert på allerede eksisterende rapporter, har VKM ikke gjennomført et eget litteratursøk i denne vurderingen.