Diet and Health Issues of Sweden

By: Candice Carlson10/10/11

Nutrition 3420, 2011

Overview• Background

• Traditional Dietary Practices

• Dietary Analysis Results

• Special Occasions

• Traditional Health Care Practices

• Diet and Health Issues

• Communication

Background Information on Sweden

• Capital: Stockholm

• Scandinavian countries include: Sweden, Norway, Denmark, Finland, and Iceland.

• Fourth Largest Country in Europe

• Swedish’s diet is one of the world’s most innovative. – Simple and hearty. IKEA, 2007

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

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

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

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

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

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 mealJacob & Ashkenazi, 2007

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

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

Herring

• Fishing for herring– Autumn and spring

• Once caught, if not served fresh it’s 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

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 – 3rd Thursday in August– Sold for 2 to 3 weeks until supplies run out– Traditionally eat when first leaves fall from trees

Moss, 2008Proctor & Roland, 2009

Surströmming

• When the tins open the scent releases– Restaurants won’t 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

Swedish Delicacies

Swedish Meatballs Jansson’s Frestelse

Swedish casserole made with potatoes, onions, bread crumbs, butter, cream, and anchovies

Served with boiled potatoes, gravy, and lingonberry jam

IKEA, 2007

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, 2009Kittler & Sucher, 2008

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

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

Family Meal

• Eating with friends isn’t 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

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

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

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, 2008Notaker, 2009

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

Proper Meal

• Consists of meat, potatoes, and one or more vegetable side dishes and sauces1. Main Dish (center)- meat, fish, or vegetable2. Staple- consists of potatoes, rice, pasta3. Side dish- Vegetable (Raw or cooked)4. Accompaniments (hot and cold sauces)5. Bread

• Proper meal made from scratch

Notaker, 2009

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

Diet AnalysisName: Lucy Height: 5 ft. 7 in. Weight 130 lbs, active

• Breakfast:1 pancake2 oz. sausage1 T. Jam1 T. butter1 slice bread

• Lunch:3 oz. salmon1 cup mashed potatoes1.5 cup salad2 T. salad dressing1 slice bread

• Dinner4 pieces pickled herring7 oz. cabbage1.5 c. mashed potatoes1 slice bread

• Snacks1 cinnamon bun1 slice bread0.5 cup cucumbers

• DrinksCoffee, milk, pear juice, apple juice

Diet Analysis, 2009

Diet Analysis Results My PyramidGoal* Actual % Goal

Grains 9.0 oz. eq. tips 6.5 oz. eq. 71.7%

Vegetables 3.5 cup eq. tips 3.7 cup eq. 105.2%

Fruits 2.0 cup eq. tips 1.6 cup eq. 82.2%

Dairy 3.0 cup eq. tips 2 cup eq. 66.7%

Protein Foods

6.5 oz. eq. tips 9.2 oz. eq. 140.8%

Empty Calories

410.0 694.3 169.3%

Diet Analysis, 2009

Results are based on a 2479 calorie diet

Macronutrient RangesCarbs 46%, Protein 14%, Fat 40%

Diet Analysis, 2009

Dietary Analysis Fat and Cholesterol

Results

Saturat

ed Fat

Monounsaturat

ed Fat

Polyunsat

urated Fa

t

Unspecifi

ed0

2

4

6

8

10

12

14

16

Fat Breakdown

Fat Breakdown

Saturated fat: 15%Monounsaturated fat: 11%Polyunsaturated fat: 5%Unspecified 8%

Cholesterol: 229 mg

Dietary Analysis, 2009

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

Dietary Analysis Results Vitamins and Minerals

Vitamin A

Vitamin E

Folat

eIro

n

Magnesiu

m

Potassiu

m Zinc

0102030405060708090

100

% DRI

% DRI

Diet Analysis, 2009

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, breadDiet Analysis, 2009

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

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

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

Walpurgis Night• April 30th

• Celebrate arrival of Spring– Big Bonfires– Male voice choirs

• One of the World’s most choral countries.

• Feast is followed.– Jansson’s Temptation– Served with crisp bread,

cheese, beer, Swedish vodka IKEA, 2007

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

Saint Lucia• December 13th

• 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

Christmas Eve

• Father Christmas comes on December 24th. • 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, 2007Kittler & Sucher, 2008

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.• Swede’s are enthusiastic about tradition– Many are Christian– Evangelical Lutheran church

Kittler & Sucher, 2008

Obesity and Weight Issues• Increasing amount of people overweight• Problem since the 1960’s• 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,2007Notaker 2009Wallstrom, Bjartell, Gullburg, Olsson & Wirfalt, 2009

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

Summary• Sweden’s diet is simple and hearty.• Staple foods consist of potatoes, wheat, rye, fish (herring),

beef, pork, dairy products. • Delicacies include; Herring (Baltic), Swedish Meatballs,

Jansson’s 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.

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). Ikea’s 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.

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.