Healthy and sustainability diets: Latest updates on Nordic Nutrition Recommendations

What are the NNR? Why are they important?

The NNR report is an international, high-quality science-based advisory for national authorities. For several decades, the NNR have served as a key scientific foundation for national food and health policies in the five Nordic and three Baltic countries. It is, for example, the basis for national nutrition recommendations, dietary guidelines, food labelling, taxes and regulations, education, monitoring, and research. In light of this being a rapidly developing research field and the emergence of more advanced methodologies for synthetising nutrition research, the report has been updated every eight to ten years. The new edition will be released in June 2023. 

What sets this report apart from previous reports?

The new edition of the NNR (NNR2022) builds on the solid foundation of the previous edition, but there are also several improvements and extensions. There has been a significant improvement in the methodology for summarising scientific evidence. The methodology used for the new edition is much more systematic, open and transparent, with a large number of checks and balances. The project has grown considerably in terms of the number of scientists involved, now approaching 400. Another major difference from previous reports is the integration of sustainability. We have also added new separate background papers on choline, a “new” nutrient, and dietary fiber. In addition, we have extended the section on food-based dietary guidelines by adding 15 new food groups papers in addition to meal patterns and dietary patterns. 

Can you describe the process and methodology for the new edition?

For the entire first year of the project period, we worked on the methodology for summarising scientific evidence. We defined the methodology, the inclusion and exclusion criteria for the scientific reviews with best quality and coined these reports “qualified systematic reviews”. These reviews are often large technical reports, typically several hundred pages long covering specific narrow research questions. Our quality checks of background papers include peer reviews and public consultations. Before the final publication in June 2023, more than 60 background papers as well as the final NNR report will have been open for public consultation for periods of eight weeks. Our improved methodology has attracted the interest of several major health authorities around the world, and the NNR have been included within a group of major international authorities with the aim of harmonising methodologies for developing nutritional recommendations and dietary guidelines. 

Who are the experts involved in this project?

We have a policy of not announcing the scientists contributing to the background papers before the papers are published. There is huge interest from stakeholders, industries, organisations, and individuals, and we will not be open to influencing or lobbying the opinion of the scientists. All stakeholders are instead invited to comment on the background papers during the public consultations to ensure this is done in an open and transparent way. When papers are published, all authors, peer reviewers, and reference groups involved will of course be openly published. 

How do you work with the different aspects of sustainability and why is sustainability relevant for the NNR?

The Nordic Council of Ministers requested that we incorporate sustainability into the food-based dietary guidelines because food systems (that is all steps from primary production to food consumption and waste) have major impacts on all dimensions of sustainability. For example, global food systems are responsible for more than one-third of all greenhouse gas emissions and are a leading cause of loss of nature and biodiversity. We focus especially on how the Nordic and Baltic food systems contribute to these environmental challenges. We also consider aspects of the socio-economic dimensions of sustainability. We have recruited a large number of sustainability scientists from the Nordic and Baltic countries who are developing sustainability background papers.  

How are you incorporating sustainability into the new edition of the NNR?

We have carefully considered the methodology for integrating sustainability. A mathematical modelling approach has been suggested, but the methodology is still not mature and such modelling often includes “black boxes” which do not transparently present the reasoning for setting such guidelines. We have therefore concluded that we first will consider the health outcomes separately before we consider the environmental dimensions of sustainability. Finally, other aspects of sustainability are addressed. We will be transparent and clearly state in the final report if, and how, sustainability issues affect the health-based guidelines. 

In this edition, you are co-operating with Chatham House. How will you ensure that the recommendations are applicable to a Nordic and Baltic context?

The majority of the sustainability experts in the NNR project are from the Nordic and Baltic countries and are highly competent within a local context. However, sustainability can not only be considered in a local context. More than half of the food we consume is imported, and our food consumption has a huge impact on all dimensions of sustainability in many vulnerable regions in the world. Therefore, the environmental dimension must also be viewed in a global context.  That is why we have collaborated with Chatham House, to ensure this global view in two of the five background papers on sustainability aspects. The recruitment of Chatham House was based on an extensive search of scientific and grey literature. Several world-leading independent institutes with experience in the synthesis of science in the field of sustainability were identified. After careful consideration, Chatham House was recruited in a regular procurement process in line with official procurement procedures for research projects. 

What will happen after the publication of the NNR2022?

The NNR are not national recommendations and guidelines, but science advice for national authorities. After the completion and submission of the NNR report, the national authorities in the Nordic and Baltic countries need to implement the science advice into their national policies. It is a tradition that nutrition recommendations are translated into national recommendations without adjustment. In terms of the food-based dietary guidelines, there is typically more flexibility between the countries in the exact formulation of the statements. While the scientific basis is the same, the local context also needs to be considered in food-based dietary guidelines. When considering sustainability, the countries might also want to prioritise things differently based on their local contexts. 

We also consider aspects of the socio-economic dimensions of sustainability. We have recruited a large number of sustainability scientists from the Nordic and Baltic countries who are developing sustainability background papers.

Rune Blomhoff, project leader of the NNR

About the Nordic Nutrition Recommendations

The Nordic Nutrition Recommendations (NNR) constitute the scientific basis for national nutrient recommendations and food-based dietary guidelines in Denmark, Finland, Iceland, Norway and Sweden. The international co-operation between the five Nordic nations has resulted in five previous editions of the NNR. 

The first edition of the NNR was published in 1980, and they are the subject of much international interest. The current version, published in 2012, has been downloaded more than 100,000 times by decision-makers, researchers and students all over the world.  

The new edition of the NNR is planned to be published in June 2023. In addition to include an update on recommendations for energy, macro- and micronutrients, NNR2022 will develop evidence-based platforms for the national food-based dietary guidelines as well as the integration of overweight and obesity, and sustainability and environmental issues into the food-based dietary guidelines.