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Background: Nutri-Score is a front-of-pack label grading foods and beverages from A to E indicating nutritional quality based on the foods' favorable and unfavorable components, and a contender in the ongoing debate on the possible implementation of a harmonized mandatory front-of-pack nutrition label in the European Union. NewTools is a research project on scoring systems for foods involving 28 partners representing actors involved in the Norwegian food system., Objective: This study aimed to explore views reported by Norwegian food system actors on the advantages and disadvantages with the updated Nutri-Score algorithms for food and beverages (2022-2023). This included Nutri-Score's performance in ranking foods according to the national food-based dietary guidelines and to the nutritional challenges in Norway., Design: A total of 28 project partners and 15 other food system stakeholders following the NewTools-project were invited to provide responses on the Nutri-Score algorithms and their application on foods and beverages in the Norwegian food composition table. Thirteen written responses were received and analyzed with qualitative content analysis., Results: The responses to the updated Nutri-Score varied in content, reflecting mainly concerns. Examples of perceived concerns included excessive penalty of salt content; insufficient differentiation based on fat content in meat, sausages, cheese, and milk; and several unreasonable comparisons across food categories. They also expressed a concern that Nutri-Score may stimulate to increased food processing, and some reported inconsistencies between Nutri-Score's classification of foods and national nutrition guidelines and policies., Discussion and Conclusion: Several concerns with the updated Nutri-Score algorithms were raised, including the weighting of specific nutrients, unfair outcomes when comparing across food categories, and inconsistencies with established Norwegian nutrition guidelines and policies. The results should be interpreted with caution, as some perspectives from the Norwegian food system may be missing., Competing Interests: The authors have nothing to declare. This manuscript is part of the NewTools-project involving actors from across the Norwegian food system, including partners with financial and political interests. Research integrity is secured through a defined framework of collaboration. ‘The NewTools-project – Developing tools for food system transformation, including food summary scores for nutrition and sustainability’ is funded by the Research Council of Norway (Project No. 326888). The 28 project partners also contribute to a varying degree through self-financing of own activities. Neither the Research Council of Norway nor the food system actors providing written submissions in the present study influenced the analysis or writing of this paper., (© 2024 Mari Mohn Paulsen et al.)

Background: In Norway, there is a lack of knowledge about the iodine status in the general and older adult population, and there is no established national monitoring programme for iodine. Several studies have indicated that iodine deficiency is prevalent in subgroups of the population. Salt iodisation is currently being considered as a measure to increase the population iodine status. In this cross-sectional study, the aim was to evaluate iodine status and determinants in the adult and older adult population in Mid-Norway, before salt iodisation is likely to be initiated., Methods: The study sample was a subsample of participants in the fourth wave of the population-based Trøndelag Health Study (HUNT4, 2017-2019) with available spot-urine samples. This subsample included participants with 25-64 years ( n = 500) and 70-79 years ( n = 250). The urine samples were analysed for iodine and creatinine. Information on the habitual intake of milk/yoghurt, fish, supplement use, use of thyroid medication and relevant background factors was collected through a general questionnaire. Multivariable quantile regression was used to model differences in the median urinary iodine concentration (UIC) by determinants. Estimates were weighted to match the age and sex distribution of the Norwegian population aged 25-79 years in 2019., Results: Median UIC was 97 µg/L (95% confidence interval [CI]: 92, 103) indicating borderline iodine deficiency at a group level. The median UIC increased with age, and iodine status was insufficient in participants below age 55 years (median 92 µg/L [95% CI: 85, 99]). Important determinants of UIC were habitual milk/yoghurt intake, daily supplement use and current use of thyroid medication, but not intake of lean or fatty fish. Risk of mild-to-moderate iodine deficiency was seen in those with a low intake of milk/yoghurt, no supplement use and who did not use thyroid medication. No group was identified as being at risk of iodine excess., Conclusion: Iodine status was adequate in older adults but mildly deficient in adults under 55 years. Milk intake, supplement use and use of thyroid medication are important determinants of iodine intake in Norway., Competing Interests: The authors declare no potential conflicts of interest., (© 2024 Marianne Hope Abel et al.)

Background: Norway is lacking a population-based national monitoring program for iodine, sodium, and vitamin D status., Objective: The aim of this study was to pilot-test a study design for collecting biological samples from a country-representative sample of 2-year-old children and their mothers and to report results for iodine, salt, and vitamin D at baseline, before initiation of salt iodization in Norway., Design: In a cross-sectional study, we recruited 2-year-old children and their mothers during the routine 2-year check-up through 38 randomly selected health clinics in 2021. Spot urine samples were analyzed for iodine, creatinine, and sodium, and dried blood spots from the mothers were analyzed for thyroglobulin (Tg) and 25-hydroxyvitamin D (25(OH)D)., Results: We aimed at including 400 mother-child pairs but recruited only 55 pairs. Major challenges were closed health clinics due to the COVID-19 pandemic, lack of motivation of the health personnel to prioritize recruiting, missing information about non-participation, and high workload for participants. The median urinary iodine concentration (UIC) was 123 (95% CI: 76, 228) µg/L in the toddlers and 83 (95% CI: 72, 99) µg/L in the mothers. The median urinary sodium concentration (UNaC) was 62 (95% CI: 37, 91) mmol/L in the toddlers and 93 (95% CI: 77, 107) mmol/L in the mothers. Of the mothers, 18% had levels of 25(OH)D <50 nmol/L (suboptimal status)., Discussion and Conclusion: Lessons learned from the pilot study will be used to design a national monitoring program for toddlers and women of childbearing age in Norway. The results indicate that 2-year-old children and women of childbearing age in Norway may have inadequate iodine intakes at the group level, while for vitamin D, most of the mothers had adequate status., Competing Interests: This study received funding from the Norwegian Ministry of Health and Care Services [the Norwegian Institute of Public Health and Oslo Metropolitan University]. The authors declare no potential conflicts of interest., (© 2023 Synne Groufh-Jacobsen et al.)

Background: Dairy products account for approximately 60% of the iodine intake in the Norwegian population. The iodine concentration in cow's milk varies considerably, depending on feeding practices, season, and amount of iodine and rapeseed products in cow fodder. The variation in iodine in milk affects the risk of iodine deficiency or excess in the population., Objective: The first goal of this study was to develop a model to predict the iodine concentration in milk based on the concentration of iodine and rapeseed or glucosinolate in feed, as a tool to securing stable iodine concentration in milk. A second aim was to estimate the impact of different iodine levels in milk on iodine nutrition in the Norwegian population., Design: Two models were developed on the basis of results from eight published and two unpublished studies from the past 20 years. The models were based on different iodine concentrations in the fodder combined with either glucosinolate (Model 1) or rapeseed cake/meal (Model 2). To illustrate the impact of different iodine concentrations in milk on iodine intake, we simulated the iodine contribution from dairy products in different population groups based on food intake data in the most recent dietary surveys in Norway., Results: The models developed could predict iodine concentration in milk. Cross-validation showed good fit and confirmed the explanatory power of the models. Our calculations showed that dairy products with current iodine level in milk (200 µg/kg) cover 68, 49, 108 and 56% of the daily iodine requirements for men, women, 2-year-old children, and pregnant women, respectively., Conclusions: Securing a stable level of iodine in milk by adjusting iodine concentration in different cow feeds is thus important for preventing excess intake in small children and iodine deficiency in pregnant and non-pregnant women.