ArticlePDF Available

The Whole Grain Partnership—How a Public–Private Partnership Helped Increase Whole Grain Intake in Denmark

Authors:

Abstract

In less than a decade, the average whole grain intake of Danes increased from 36 to 63 g/10 MJ/day. In this article the history, organization, and results of the long-lasting Danish Whole Grain Partnership are described. The evidence providing the foundation of the partnership’s work, important lessons learned, and key strategic elements are also discussed. The ultimate aim is to gather recommendations for the international community on how to engage in public–private partnerships with the purpose of promoting healthy diets.
6.6.2019 The Whole Grain Partnership—How a Public–Private Partnership Helped Increase Whole Grain Intake in Denmark
https://www.aaccnet.org/publications/cfw/2019/May-June/Pages/CFW-64-3-0027.aspx 1/9
Features
Cereal Foods World, Vol. 64, No. 3
DOI: https://doi.org/10.1094/CFW-64-3-0027
The Whole Grain PartnershipHow a
The Whole Grain PartnershipHow a
The Whole Grain PartnershipHow a
The Whole Grain PartnershipHow a
The Whole Grain PartnershipHow a
PublicPrivate Partnership Helped Increase
PublicPrivate Partnership Helped Increase
PublicPrivate Partnership Helped Increase
PublicPrivate Partnership Helped Increase
PublicPrivate Partnership Helped Increase
Whole Grain Intake in Denmark
Whole Grain Intake in Denmark
Whole Grain Intake in Denmark
Whole Grain Intake in Denmark
Whole Grain Intake in Denmark
Sofia Lourenço,1,2 Gitte Laub Hansen,3 Bente Stærk,4 Per Frank,5 and Camilla Toft Petersen6
1 Danish Cancer Society, Strandboulevarden 49, DK-2100 Copenhagen, Denmark. Tel: +45 35 25 74 21; E-mail: soflou@cancer.dk; LinkedIn:
www.linkedin.com/in/sofiamlourenco
2 Corresponding author. Sofia Lourenço, Prevention & Information | Diet & Physical Activity, Danish Cancer Society, Strandboulevarden 49, DK-2100
Copenhagen, Denmark. E-mail: soflou@cancer.dk
3 Danish Cancer Society, Strandboulevarden 49, DK-2100 Copenhagen, Denmark. Tel: +45 35 25 75 47. E-mail: glh@cancer.dk
4 Danish Veterinary and Food Administration, Stationsparken 31-33, DK-2600 Copenhagen, Denmark. Tel: +45 72 27 69 00; E-mail: BEST@fvst.dk
5 Nestlé Sweden AB, Karlavägen 102, SE-115 26 Stockholm, Sweden. Tel: +46 (0)72 537 45 05; E-mail: Per.Frank@se.nestle.com; LinkedIn:
www.linkedin.com/in/per-frank
6 Whole Grain Partnership, H. C. Andersens Boulevard 18, DK-1553 Copenhagen, Denmark. Tel: +45 30 38 15 46; E-mail: catp@di.dk
© 2019 AACC International, Inc.
Abstract
In less than a decade, the average whole grain intake of Danes increased from 36 to 63 g/10 MJ/day. In this article the
history, organization, and results of the long-lasting Danish Whole Grain Partnership are described. The evidence
providing the foundation of the partnership’s work, important lessons learned, and key strategic elements are also
discussed. The ultimate aim is to gather recommendations for the international community on how to engage in public–
private partnerships with the purpose of promoting healthy diets.
Consumption of dietary whole grains helps prevent noncommunicable diseases (NCDs) such as cardiovascular
diseases, type 2 diabetes, and colorectal, pancreatic, and gastric cancers (3,13). Whole grain intake also has a
beneficial effect on body weight, waist circumference, and body fat mass (13). Despite these benefits, 92.4% of the
global adult population does not meet recommendations for whole grain intake, and in fact, whole grain intake
decreased between 1990 and 2010 (17). In Denmark, whole grain intake similarly decreased during the 1990s and
2000s (6,14), and the Whole Grain Partnership (WGP) was established to counteract this development. In this article,
we describe the development of this public–private partnership, results achieved so far, lessons learned, and
implications for future initiatives.
The WGP was created due to a growing concern about decreasing whole grain intake in the Danish population in the
mid-2000s. Some of the future partners were concerned by the increasing popularity of low-carb, fat-rich diets (e.g.,
Atkins) that seemed to be part of a general trend leading to a significant decline in the intake of whole grain breads (i.e.,
traditional Danish rye bread) (10). At the same time, millers, bread producers, and bakeries were experiencing
weakened demand for their products (10). In parallel with this development, non-governmental organizations (NGOs)
became increasingly aware of the growing evidence on the health benefits of whole grains. Together, these factors
provided a window of opportunity for the establishment of a new partnership to promote whole grain consumption in
6.6.2019 The Whole Grain Partnership—How a Public–Private Partnership Helped Increase Whole Grain Intake in Denmark
https://www.aaccnet.org/publications/cfw/2019/May-June/Pages/CFW-64-3-0027.aspx 2/9
Denmark. The first joint meeting of representatives from the food industry, health NGOs, and the Danish Veterinary and
Food Administration (DVFA) took place in 2007, and it was clear that no other forum could “lift the debate and facilitate a
common direction” across sectors for the benefit of consumers (10). Inspired by the successes of the “6 a day”
partnership, and the Whole Grain Council in the United States, the group decided to clarify the definition of whole grain,
research the evidence on the health benefits of whole grains, and develop dietary guidelines for whole grain intake.
These steps proved sufficient to formally establish the WGP in 2008 with 14 partners across a variety of sectors. The
number of partners has more than doubled since 2008, and at the time this article was written, there were 31 partners.
It was deemed essential to start the work of the WGP by establishing a knowledge base for whole grain. In 2007, there
was neither an official definition of whole grain nor specific dietary guidelines for whole grain intake in Denmark. The
national dietary guidelines only recommended the intake of “coarse” bread and provided generic considerations about
the types of cereals and cereal products to select (1). The DVFA, therefore, commissioned the National Food Institute
(NFI) at the Technical University of Denmark to provide a scientific review (14). In addition, a sociocultural study on the
perception of whole grains that helped define target groups was funded by innovation funds from the Ministry of Food,
Agriculture and Fisheries of Denmark and some of the future WGP partners (11).
Definition of Whole Grain
The NFI report provided the following definition of whole grain: “whole grain is defined as intact and processed
(dehulled, ground, cracked, flaked or the like) grains, where the components endosperm, bran and germ are present in
the same proportions as in the intact grain” (14). The definition of whole grain includes grain seeds from the following
genera of the grass family Gramineae: barley (Hordeum), oat (Avena), wheat (Triticum), rye (Secale), rice (Oryza), millet
(Panicum), maize (Zea; only dried maize), and sorghum (Sorghum). The definition also includes grain seeds from
species, hybrids, and cultivars from these genera. The definition was unanimously accepted by all WGP partners.
Evidence of the Health Effects of Whole Grains
The NFI review on the health effects of whole grains was based on prospective population studies. It concluded that
cohort studies showed inverse associations between the intake of whole grains and the risk of heart disease (i.e., total
heart disease, coronary heart disease, and stroke), type 2 diabetes, and overweight (14). The effects of whole grain
intake on cancer development differed with cancer type, and the positive effects of whole grain intake were not
pronounced (14). More recent research has shown that a high intake of dietary fiber, especially cereal fiber and whole
grain fiber, is associated with a reduced risk of colorectal (2,19), pancreatic, and gastric cancers and that whole grain
intake is associated with a reduced risk of both total cancer and mortality from all causes (3). In fact, low whole grain
intake is considered the second largest dietary health risk, both globally and in Denmark specifically (9).
Dietary Guidelines for Whole Grain
The NFI study recommended a whole grain intake of 4 servings/day, corresponding to a minimum of 75 g of whole
grain/10 MJ/day, based on the average Danish diet (14). The recommendation is adjusted for dietary needs, so for
young children (4–10 years of age) and adults who follow a light diet a whole grain intake of 40–60 g/day is
recommended (14). This recommendation was incorporated in the national dietary guidelines in 2009, and the term
“coarse bread” was replaced with “whole grain bread” (4). An independent dietary guideline to “choose whole grain” was
introduced in the national dietary guidelines in 2013 together with the recommendation to “eat at least 75 g whole grain
per day” (5).
Whole Grain Logo
The WGP agreed it was important to find a
trustworthy way to inform consumers about the content of whole grain on product packaging and to help consumers
recognize whole grain products (10). In 2007–2008, a workgroup chaired by the DVFA, including representatives from
all types of WGP partner organizations, decided to develop a whole grain logo that communicates nutritional advice on
behalf of Danish authorities. This group further defined the nutritional criteria for the logo (Table I) and developed the
whole grain logo as a visual brand (Fig. 1) (7). The logo was launched in January 2009 (7), and the WGP has published
a manual that covers all aspects of the use and promotion of the whole grain logo (18). In addition to the compositional
criteria for whole grain (Table I), products bearing the whole grain logo must fulfill the nutrient profile required for use of
the Nordic Keyhole nutrition label to ensure its nutritional credibility and avoid its use with otherwise “unhealthy”
products that are high in fat, sugar, or salt (e.g., biscuits [cookies] or cakes) (18). Furthermore, the following statement is
mandatory on product packaging: “The Danish Veterinary and Food Administration recommends 75 g whole grain per
6.6.2019 The Whole Grain Partnership—How a Public–Private Partnership Helped Increase Whole Grain Intake in Denmark
https://www.aaccnet.org/publications/cfw/2019/May-June/Pages/CFW-64-3-0027.aspx 3/9
day as part of a varied diet,” and “This product contains XX g whole grain per 100 g” (18). The whole grain logo,
therefore, is both a claim for high whole grain content and a promotion of the national dietary guidelines. Use of a
trustworthy logo and promotion thereof became a key incentive for the food industry in the development of new products
with a high whole grain content that could stand out from less healthy cereal-based products (10). The whole grain logo
is a registered trademark and legally owned by the DVFA and is part of the ordinary labeling control of both
prepackaged and unpackaged products.
How the WGP Works
Organization. The WGP is formally organized, with a board, group of partner members, and secretariat. The board of
directors includes seven representatives from three major partner categories: the DVFA, health NGOs, and the food
industry. There is one board chair and two vice chairs representing each partner category. The board is responsible for
making decisions regarding and approving strategy, yearly action plans, budgets, and partnership financing.
The WGP comprises partners from health authorities, health NGOs, and the food industry, such as millers, craft
bakeries, industrial food producers, retailers, and interest groups. Members participate in two partnership meetings a
year and engage in small thematic workgroups. All partners are responsible for executing WGP campaigns. A complete
list of members is available at www.fuldkorn.dk.
The partnership is managed by a secretariat with two full-time employees—a campaign manager and a campaign
assistant—as well as a part-time student assistant. The campaign manager is responsible for the daily management of
the WGP, serving board operations, managing stakeholders, and coordinating campaign activities. The secretariat
develops action plans in collaboration with the partners, develops and implements awareness campaigns and other joint
activities for partners, coordinates workgroups, and manages both internal and external communications.
All members cofinance the WGP. Membership fees are determined by the board and approved by all partners (10). The
total 2018 budget was DKK2.5 million, excluding VAT (approximately EUR335.000), and included both secretariat
salaries and financing for all activities.
Partner Roles. Each partner plays an important role in the functioning and execution of activities under the auspices of
the WGP (Fig. 2). The DVFA is responsible for the enforcement of the whole grain logo criteria. It communicates the
importance of whole grains as part of a healthy diet through educational materials for the public and development of
guidelines for healthy meals for relevant professionals. It also contributes to the legitimacy and promotion of whole grain
campaigns through the dissemination of the national dietary guidelines.
6.6.2019 The Whole Grain Partnership—How a Public–Private Partnership Helped Increase Whole Grain Intake in Denmark
https://www.aaccnet.org/publications/cfw/2019/May-June/Pages/CFW-64-3-0027.aspx 4/9
Health NGO partners also contribute to the trustworthiness of WGP campaigns and endorsement of the national dietary
guidelines. They communicate information about the beneficial effects of whole grains and their risk-reducing effects on
NCDs and add to the evidence base by funding clinical and epidemiological research. Both the DVFA and health NGO
partners focus on encouraging Danes to eat more whole grains. Legislation is very strict with regard to health claims
made by the food industry and retailers on product packaging and through marketing, thus the health benefits of whole
grains are communicated to the public by health NGOs and the DVFA through dietary guidelines and press activities.
Partners from the food industry are responsible for the supply of tasty whole grain products that meet the whole grain
logo criteria and the reformulation of products that do not yet meet these criteria. Reliable package labeling and
application of the whole grain logo, as well as other marketing and public relations activities, are important channels for
communicating information about whole grains to consumers. Retailers further ensure the distribution and marketing of
whole grain products through in-store activities and special deals. The whole grain logo gives partners a competitive
advantage in the market and has helped expand the market for new whole grain products.
Strategy. The WGP’s philosophy is that the more
organizations work toward a common vision and mission, the better the results will be (10). The WGP’s common vision
is to “promote public health by encouraging Danes to eat more whole grains,” and the partnership’s mission is to
“increase the availability of whole grain products and public awareness of the health benefits of whole grains” (8).
As illustrated in Figure 3, the partnership’s strategy is fourfold: 1) increase the availability of tasty whole grain products;
2) promote the development of new whole grain products and the incorporation of whole grains in all cereal-based
products, even products that do not carry the whole grain logo; 3) promote the whole grain logo, inform Danes about the
health benefits of whole grains, and dispel myths about whole grains; and 4) help shape new norms for whole grains
through campaigns, events, and structural changes. Together, these efforts ensure both consumer demand and a
supply of high-quality whole grain products.
Even though dietary changes take time, the WGP’s goals have been ambitious from the beginning: an incremental
change in the mean population intake of whole grains from 32 to 44 g/day (Table II). In the meantime, new goals
regarding awareness of the whole grain logo and its use by consumers, the number of whole grain logo-labeled
products, and the sales growth of whole grain products are regularly monitored to evaluate the WGP’s performance.
6.6.2019 The Whole Grain Partnership—How a Public–Private Partnership Helped Increase Whole Grain Intake in Denmark
https://www.aaccnet.org/publications/cfw/2019/May-June/Pages/CFW-64-3-0027.aspx 5/9
Target Group. The WGP target group is the Danish population in general, although there is a special emphasis on
groups with the lowest whole grain intakes. The sociocultural study conducted shortly after the creation of the WGP
aimed to understand how Danish consumers experience bread and whole grains (11). The study showed that Danes
perceive whole grains as healthy. However, their perception of what a whole grain product is does not necessarily
correspond to the scientific definition, and it is difficult to judge whether a product is whole grain based on its
appearance (11). The study also found that cultural consumption patterns for bread differ considerably between work
and leisure scenarios, although these patterns were not definite (11). The study provided a number of recommendations
that the WGP has drawn upon for its communication and campaign activities.
Communication Activities. Every year, partners agree on an action plan that can comprise a variable number of
elements, including seminars, workshops, public events, in-store and online campaigns, media campaigns,
development of educational materials (e.g., for vocational schools, retail employees, bakers, eateries, etc.), and a
National Whole Grain Day. In January 2018, National Whole Grain Day events engaged approximately 1,200
institutions, such as municipalities, schools, and workplace eateries, providing consumers with many samples of whole
grain products. The WGP also disseminates its messages through flyers, postcards, campaign posters, a partner
toolbox, recipes, the www.fuldkorn.dk website, social media profiles, and a free app.
Whole Grain Intake in Denmark. The NFI is responsible for conducting national diet surveys in Denmark. Based on
data from these surveys, complemented with Danish market data on the whole grain content in foods, the whole grain
intake of the Danish population was calculated for the periods 2000–2004 and 2011–2013 (15). The results show a
substantial increase in average whole grain intake after the establishment of the WGP in 2008 (Fig. 4) that equates to
Danes now eating, on average, 84% of the recommended 75 g of whole grains/day (15). The results were even more
positive for children, for whom whole grain intake more than doubled during the same period (16). A stratified age
analysis shows that increases in whole grain intake for all age subgroups (4–6, 7–10, and 11–14 years of age) were
significant (12). Despite these very positive results, 70% of the general Danish population still does not meet the
recommendation for whole grain intake. Whole grain intake increased from 36 to 63 g/MJ in the general population,
whereas the increase was from 12 to 23 g/10 MJ for the first quartile (16). Although the increase observed in the first
quartile is satisfactory, increasing whole grain intake for low whole grain consumers is an ongoing challenge and calls
for actions aimed specifically at this group. However, no pronounced age or gender differences were found among the
first quartile (16). For 2000–2004, there was a weak trend showing lower whole grain intake among young males (19–24
years of age), but this trend was not detected in the data for 2011–2013 (16). The rather nonspecific sociodemographic
characteristics for the first quartile makes it challenging to develop specific interventions and campaigns targeting this
group.
Availability of Whole Grain Products. The number of products carrying the whole grain logo has increased
dramatically since the inception of the WGP—from 150 registered products in 2009 to about 800 in 2018. This increase
6.6.2019 The Whole Grain Partnership—How a Public–Private Partnership Helped Increase Whole Grain Intake in Denmark
https://www.aaccnet.org/publications/cfw/2019/May-June/Pages/CFW-64-3-0027.aspx 6/9
reflects both the reformulation of existing products and the development of new whole grain products that appeal to new
consumer groups.
For both adults and children, lunch accounts for about half of the daily whole grain intake, probably due to the Danish
tradition of eating open-face rye bread sandwiches for this meal. Oats are the second largest source of whole grain in
the Danish diet, accounting for 12 and 9% for children and adults, respectively. Following oats, the most common
sources are other types of whole grain bread and muesli (14).
Consumer Awareness and Attitudes toward the Whole Grain Logo. The progress of the WGP’s work is
continuously evaluated through market surveys. Since its launch in 2009, awareness of the whole grain logo has
increased from 20 to 70% in 2018. In the latest YouGov survey, 48% of consumers who know about the whole grain
logo indicate they look for it when buying groceries, and 68% think the logo is trustworthy (YouGov analysis for the
Danish WGP 2018, unpublished data).
WGP Experience and Recommendations
The most important lesson learned is that building an effective public–private partnership takes time. The cornerstones
of the WGP are a solid evidence base; the continuous development of effective interventions and campaigns; a well-
functioning organization with a professional secretariat; the building of mutual trust between partners; and the
establishment of common goals (10).
Based on the WGP’s experiences we recommend three key strategic elements be incorporated: solid evidence and
knowledge; interventions; and a spirit of partnership (Fig. 5). Reaching consensus on the evidence concerning the
health benefits of whole grains; developing a clear definition of whole grain; understanding consumer behaviors and
assumptions about whole grains; observing the development of food trends; continually documenting the partnership’s
results; and monitoring the whole grain intake of the general population are essential pillars for the establishment of
common goals
The development of effective interventions requires an ample supply of whole grain products provided by partners, as
well as demand among consumers, which is mainly achieved through communication activities coordinated by the
secretariat and widely implemented by WGP members. All partners must commit to participating and sharing resources,
and experience shows that the more members engage in partnership activities the more they benefit from the
partnership.
Finally, to create a well-functioning public–private partnership, it is critical to ensure professional management that
promotes equality, transparency, and democratic decision processes and, at the same time, supports a clear distribution
of roles among partner organizations. Furthermore, it is important to highlight that members share risks, but also enjoy
clear advantages gained from being part of the partnership when mutual trust and respect are maintained (10). It is vital
to continuously monitor results and celebrate successes to achieve the level of synergy necessary for members to
comply with the common goals of the partnership (Fig. 6).
Conclusions and Perspectives
A 75% increase in whole grain intake for the general population and an increase of 218% for children is a public health
success that was achieved in less than a decade in Denmark. This success was possible due to the joint efforts of both
health authorities, health NGOs, and the food industry gathered in the WGP, which led to a considerable increase in the
supply of whole grain products with a higher whole grain content and helped consumers gain knowledge about and
awareness of whole grain products. Despite these results, a majority of the population still does not meet the whole
grain recommendation, and there is wide variation in the intake of whole grains. The efforts of the WGP have
contributed to a drastic change in norms concerning whole grains, and the quality of bread in Denmark has improved
6.6.2019 The Whole Grain Partnership—How a Public–Private Partnership Helped Increase Whole Grain Intake in Denmark
https://www.aaccnet.org/publications/cfw/2019/May-June/Pages/CFW-64-3-0027.aspx 7/9
considerably, both in terms of health benefits and taste. Furthermore, the positive results observed for children give
hope that this generation will maintain its higher whole grain intake into adulthood.
Acknowledgments
We thank Susanne Tøttenborg and Rikke Iben Neess for constructive feedback on the manuscript. We also thank
Heddie Mejborn for an update on the results for children; Iben Sommer for constructive feedback on the illustration of
results; and Lise Lotte Mahmoud for proofreading.
Funding
The authors wrote this article without any specific grant from funding agencies in the public, commercial, or not-for-profit
sectors.
Conflicts of Interest
None.
Sofia Lourenço, M.S. degree in human nutrition, is a senior project manager in the Department of
Prevention & Information of the Danish Cancer Society. Sofia is responsible for the evidence base for the link between
overweight, diet, and physical activity and cancer and for the correct translation of these complex messages into
layman’s terms. Her previous experience includes work with public–private partnerships promoting an increase in the
intake of whole grains in the Danish population and an increase in everyday cycling, as well as the use of the nudging
policy paradigm and its application in health and nutrition promotion arenas. Sofia has published articles on a variety of
topics, such as choice architecture in self-serving settings, the effectiveness of menu labeling, and, more recently,
estimations of the cancer prevention potential of a lower red and processed meat intake in Denmark and a higher
physical activity level in Nordic countries. LinkedIn: www.linkedin.com/in/sofiamlourenco
Gitte Laub Hansen has worked for the past eight years as an executive project manager in the
Department of Prevention & Information of the Danish Cancer Society. Gitte is trained as a food engineer and holds a
Ph.D. degree in human nutrition and epidemiology. For more than 35 years, she has worked within the field of public
health nutrition and nutrition education for different government bodies, municipalities, and universities. Gitte’s focus is
to ensure a healthy food supply and to educate the public on how to make healthy food choices, with the ultimate aim to
prevent noncommunicable diseases, particularly cancers.
Bente Stærk has worked for the past 12 years as deputy head of the Diet and Nutrition Division at the
Danish Veterinary and Food Administration. This authority is responsible for the official Danish dietary guidelines and
the promotion of healthy diets among the Danish population. Bente is trained as a food engineer. Her previous
experience includes working for the Nordic Council of Ministers on the development of the common Nordic Plan of
Action for better health and quality of life through diet and physical activity; the Confederation of Danish Industry; and
the Ministry of Agriculture. Bente’s focus is to promote healthy lifestyles through public–private partnerships that can
lead to a healthier food supply, as well as good consumer communication, making it easier for consumers to live healthy
lives.
Per Frank, Ph.D., is the Nordic nutrition, health and wellness manager at Nestlé. Per holds an M.S.
degree in nutrition, and received his Ph.D. degree in exercise physiology from the Swedish School of Health and Sport
Science at the Karolinska Institutet in Stockholm, Sweden. With broad experience from working with several food and
supplement companies, Per joined Nestlé in 2016. In his current role, Per supports the communication team with
nutritional expertise. At Nestlé, one of the world’s largest food and beverage companies, whole grain is an important
ingredient and a prioritized topic. LinkedIn: www.linkedin.com/in/per-frank
6.6.2019 The Whole Grain Partnership—How a Public–Private Partnership Helped Increase Whole Grain Intake in Denmark
https://www.aaccnet.org/publications/cfw/2019/May-June/Pages/CFW-64-3-0027.aspx 8/9
Camilla Toft Petersen is a campaign consultant at the Danish Wholegrain Partnership’s secretariat.
She holds an M.S. degree in health promotion and health strategies and environmental planning from Roskilde
University. Camilla has a great passion for the work developed within health promotion campaigns. Within the Danish
Whole Grain Partnership Camilla works with the aim to improve public health by getting Danes to eat more whole
grains. Camilla is responsible for the annual Whole Grain Day, which has more than 1,000 participants and activities
within the foodservice sector. Camilla is focused on achieving the best results through working together with all the
partners in the Danish Whole Grain Partnership.
References
1. Astrup, A., Andersen, N. L., Stender, S., and Trolle, E. Kostrådene 2005 [Danish Dietary Guidelines 2005].
Ernæringsrådet og Danmarks Fødevareforskning, Søborg, Denmark, 2005.
2. Aune, D., Chan, D. S. M., Lau, R., Vieira, R., Greenwood, D. C., Kampman, E., and Norat, T. Dietary fibre, whole grains,
and risk of colorectal cancer: Systematic review and dose-response meta-analysis of prospective studies. BMJ. DOI:
https://doi.org/10.1136/bmj.d6617. 2011.
3. Aune, D., Keum, N., Giovannucci, E., Fadnes, L. T., Boffetta, P., Greenwood, D. C., Tonstad, S., Vatten, L. J., Riboli, E.,
and Norat, T. Whole grain consumption and risk of cardiovascular disease, cancer, and all cause and cause specific
mortality: Systematic review and dose-response meta-analysis of prospective studies. BMJ. DOI:
https://doi.org/10.1136/bmj.i2716. 2016.
4. Danish Veterinary and Food Administration. Kostkompasset—Vejen til en Sund Balance [Dietary Compass—The Way to
a Healthy Balance]. DVFA, Glostrup, Denmark, 2010.
5. Danish Veterinary and Food Administration. De Ofcielle Kostråd [Danish Official Dietary Guidelines]. Published online
at https://altomkost.dk/raad-og-anbefalinger/de-officielle-kostraad. DVFA, Glostrup, Denmark, 2013.
6. Fagt, S., Matthiessen, J., Biltoft-Jensen, A., Groth, M. V., Christensen, T., Hinsch, H.-J., Hartkopp, H., Trolle, E., Lyhne,
N., and Møller, A. Udviklingen i danskernes kost 1985-2001 [Developments in the Danish dietary intake 1985-2001].
Published online at https://altomkost.dk/fileadmin/user_upload/altomkost.dk/Udviklingen_i_danskernes_kost_1985-
2001_-_sukker__alkohol.pdf. Danmarks Fødevare- og Veterinærforskning, Søborg, 2004.
7. Fuldkornspartnerskabet. Fuldkornspartnerskabets historie [Danish Whole Grain Partnership’s history]. Published online
at www.fuldkorn.dk/om-partnerskabet/73-historien. Whole Grain Partnership, Copenhagen, Denmark, 2014.
8. Fuldkornspartnerskabet. Der er fuld fart på fuldkornsbølgen [A whole grain wave in full speed]. Published online at
www.fuldkorn.dk/presse-og-nyheder#/pressreleases/der-er-fuld-fart-paa-fuldkornsboelgen-2106024. Whole Grain
Partnership, Copenhagen, Denmark, 2017.
9. GBD 2015 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 79 behavioural,
environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: A systematic analysis for the
Global Burden of Disease Study 2015. Lancet. DOI: https://doi.org/10.1016/S0140-6736(16)31679-8. 2016.
10. Greve, C., and Neess, R. I. The evolution of the Whole Grain Partnership in Denmark. Published online at
www.fuldkorn.dk/media/179349/the-evolution-of-the-whole-grain-partnership-in-denmark.pdf. Whole Grain Partnership,
Copenhagen, Denmark, 2014.
11. Jakobsen, G. S., and Jensen, A. M. B. Fuld af korn—En antropologisk undersøgelse af faglaerte og ufaglaerte
danskeres hverdagserfaringer med brød og fuldkorn [Sociocultural perceptions of whole grain]. Published online at
www.fuldkorn.dk/media/69050/fuld-af-korn-antropologisk-studie-2007.pdf. Whole Grain Partnership, Copenhagen,
Denmark, 2007.
12. Matthiessen, J., and Fagt, S. Kostens betydning for børn og unges sundhed og overvægt: 2000–2013 [The importance
of diet for health and overweight in children and adolescents: 2000–2013]. Published online at
www.food.dtu.dk/english/-/media/Institutter/Foedevareinstituttet/Publikationer/Pub-2017/E-artikel-Kostens-betydning-for-
boern-og-unges-sundhed-og-overvaegt-2000-2013.ashx?
la=da&hash=E0CBCC56470408B3F3E7F48EAA26AADC9184D37F. National Food Institute, Lyngby, Denmark, 2017.
13. McRae, M. P. Health benefits of dietary whole grains: An umbrella review of meta-analyses. J. Chiropr. Med. 16:10,
2017.
14. Mejborn, H., Biltoft-Jensen, A., Trolle, E., and Tetens I. Fuldkorn. Definition og Vidensgrundlag for Anbefaling af
Fuldkornsindtag i Danmark [Whole Grains. Definition and Knowledge Base for the Recommendation of Whole Grain
Intake in Denmark]. National Food Institute, Søborg, Denmark, 2008.
15. Mejborn, H., and Fagt, S. Far more whole grains in Danes’ diet. Published online at
www.food.dtu.dk/english/news/nutrition/Nyhed?id={EAD6A890-4843-4E43-A512-AD7CAE304518}. National Food
Institute, Lyngby, Denmark, 2014.
16. Mejborn, H., Ygil, K. H., Fagt, S., Trolle, E., Kørup, K., and Christensen T. Danskernes fuldkornsindtag 2011–2013
[Whole grain intake in Denmark]. Published online at
www.food.dtu.dk/-/media/Institutter/Foedevareinstituttet/Publikationer/Pub-2014/Danskernes_fuldkornsindtag_2011-
2013.ashx. National Food Institute, Søborg, Denmark, 2014.
17. Micha, R., Khatibzadeh, S., Shi, P., Andrews, K. G., Engell, R. E., and Mozaffarian, D. Global, regional and national
consumption of major food groups in 1990 and 2010: A systematic analysis including 266 country-specific nutrition
surveys worldwide. BMJ Open. DOI: 10.1136/bmjopen-2015-008705. 2015.
18. Whole Grain Partnership. Danish Whole Grain Logo—User Manual. Published online at
www.fuldkorn.dk/media/761076/2015-logo-manual_english.pdf. Whole Grain Partnership, Copenhagen, Denmark, 2015.
19. World Cancer Research Fund and American Institute for Cancer Research. Continuous Update Project expert report
2018. Diet, nutrition, physical activity and colorectal cancer. Available online at dietandcancerreport.org. 2018.
6.6.2019 The Whole Grain Partnership—How a Public–Private Partnership Helped Increase Whole Grain Intake in Denmark
https://www.aaccnet.org/publications/cfw/2019/May-June/Pages/CFW-64-3-0027.aspx 9/9
... Providing evidence of rationale for the aim (review of research about health benefits from increased wholegrain consumption, study of people's relationship and understanding of wholegrain); then: agreeing on definitions of wholegrain, setting goals for work (in terms of increase in population intake of wholegrain), agreeing on activities, documenting, monitoring, and evaluating processes and results Lourenço et al., 2019). ...
... Food retailers promote marketing through in-store activities and special deals. Health NGOs communicate the importance of wholegrains for health, and add to the evidence base by funding clinical and epidemiological research (Lourenço et al., 2019). ...
... A report from the partnership highlights that reaching consensus about evidence and definitions; understanding consumer behaviours and understanding; observing development of food trends; continually documenting results; and monitoring wholegrain intake are all essential pillars for the establishment of common goals which is key to success (Lourenço et al., 2019). All this takes time. ...
Technical Report
Full-text available
The global demand for food will increase in the future. To meet this demand, it is not enough simply to increase productivity in a sustainable way. We also need to change from linear mass consumption to a more circular economy — which will mean changing our norms, habits and routines. The evidence shows that this kind of behaviour change needs to happen collectively, not just individually. So we need joined-up governance at local, national and international levels. Food systems also contribute significantly to greenhouse gas emissions. This can be addressed by reducing waste or directing it back into the supply chain. A mix of different measures will be most effective. The evidence shows that taxation is one of the most effective ways to modify behaviour. Accreditation and labelling schemes can also have an impact. Meanwhile, reform of European agriculture and fisheries policies offer great opportunities to develop resilience and sustainability. But there is not yet enough evidence to know for sure exactly what works in practice, so the steps we take should be carefully evaluated, and trade-offs anticipated.
... These breads ranged from white bread to whole-grain bread to pumpernickel bread; some contained food additives, and others did not. In the mid-2000s, Denmark saw a decline in carbohydrate-rich foods in association with media claims that low-carbohydrate/high-fat diets were healthier (64). With the reduction in carbohydrate intake came lower whole-grain intakes, which in the longer term could result in poorer health outcomes. ...
... To counter this trend, a privatepublic partnership organized a campaign to increase intake of whole-grain foods. Over 10 years, the Danish national whole-grain intake doubled, with an increase of 43% in children and 27% in adults (64). This successful intervention caused significant population-level increases in wholegrain intake that could have a substantial and positive effect on public health (60,109). ...
Article
Numerous association studies and findings from a controlled feeding trial have led to the suggestion that “processed” foods are bad for health. Processing technologies and food formulation are essential for food preservation and provide access to safe, nutritious, affordable, appealing and sustainable foods for millions globally. However, food processing at any level can also cause negative health consequences that result from thermal destruction of vitamins; formation of toxins such as acrylamide; or excessive intakes of salt, sugar, and fat. Research on ultraprocessed foods centers on food composition and formulation. In addition, many modern food formulations can have poor nutritional quality and higher energy density. We outline the role of processing in the provision of a safe and secure food supply and explore the characteristics of processed foods that promote greater energy intake. Despite the potential for negative health effects, food processing and formulation represent an opportunity to apply the latest developments in technology and ingredient innovation to improve the food supply by creating foods that decrease the risk of overeating. Expected final online publication date for the Annual Review of Nutrition, Volume 42 is August 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
... One strategy is to substitute refined grains with whole grains or to launch new products with whole grains. The focus on whole grains started in the 2000s, with the introduction of a whole grain guideline in the US dietary guidelines [8], or the launch of the Danish Whole Grain Partnership in 2007 [9]. This increased focus on whole grains incentivised manufacturers to reformulate and formulate new products with whole grains [8]. ...
Article
Full-text available
The benefits of increasing populations’ and individuals’ fibre intake on non-communicable disease risk have been known and promoted for decades in the UK and in the world. Public health campaigns, including dietary recommendations, called populations to increase their consumption of whole grains, fruits and vegetables, while manufacturers increased the fibre content of their products. In particular, the SACN report in 2015 highlighted the importance of fibres for the UK population. We analysed trends in fibre consumption for the whole population, by age group and gender using the UK National Diet and Nutrition Survey from 2008/09 to 2016/17. We investigated changes in total fibre intake and calculated the contribution to fibre intake and time trends from each food group. We compared the fibre content of food groups between 2008/09 and 2016/17. We found that fibre intake remained fairly stable. While the fibre content of some cereal-based products increased, it decreased for potato-based products. All age groups derived increasing fibre from pasta and other cereal-based products, and decreasing fibre from potato products. Adults, but not children or adolescents derived more fibre from vegetables. This resulted in an increase in fibre intake in adults, but not in children or adolescents.
... The partnership includes stakeholders from the public authorities, non-governmental health organizations, and partners from the industry. The aim of the partnership is to increase the awareness of WG and to make WG and WG products more available and accessible by motivating and facilitating for the food industry to develop new WG products and thereby increase the intake of WG among the Danish population [8,9]. Moreover, a WG logo has been developed and is now used to label products with a predefined WG content to guide the consumer to purchase WG products [10]. ...
Article
Full-text available
PurposeThe aim was to analyze the intake of whole grain (WG) and associations with lifestyle and demographics in a newly established cohort of Danish adults.Methods Between 2015 and 2019, Danes were enrolled into The Diet, Cancer and Health—Next Generations cohort. A total of 38,553 persons were included in the current cross-sectional study, where all completed a 376-item food frequency questionnaire, a lifestyle questionnaire, and a physical examination in a study center where physical measurements and biological samples were collected.ResultsThe median intake of WG was 79 g/10 mega joule (MJ) and 54% of the participants consumed the amount of WG recommended in Denmark, which is 75 g/10 MJ. The probability of consuming the recommended amount of WG was highest among men, persons < 30 years, students, persons with body mass index (BMI) < 25 kg/m2, persons participating in sports, who did not exceed the recommended maximum intake of alcohol and did not smoke. The probability of having a low intake of WG defined as < 25 g/10 MJ was highest among persons with short education, BMI ≥ 25 kg/m2, persons not participating in sports, persons having an alcohol intake above the recommended maximum level and persons being active smokers.Conclusion The median intake of WG was 79 g/10 MJ. The probability of consuming at least 75 g WG/10 MJ was highest among persons who also adhered to healthy lifestyle measured by other factors. Only 6% of the cohort participants consumed < 25 g WG/10 MJ, these persons were more likely to have a general less healthy lifestyle.
Article
Full-text available
Dietary guidelines provide evidence-based guidance for healthy individuals to improve dietary patterns, although they are most often based on individual foods or food groups. Legumes are a class of food included in current Australian Dietary Guidelines (ADG), mentioned in two of the five food groups, as a vegetable and as an alternative to meat. Whole grain consumption is encouraged in ADG via the statement focused on cereal grains due to their health-promoting properties. Despite their prominence in guidelines, average legume and whole grain consumption in Australia remains lower than recommendations outlined in the ADG. This exploratory study aimed to understand consumer perspectives of wording utilised in dietary guidelines specifically focused on legumes and whole grains. Based on the analysis, there was a significant preference for the statement “each day, consume at least one serve of legumes either as a serve of vegetables or as an alternative to meat” (p < 0.05), which provides a specific frequency and quantification for legume consumption. For whole grain, the significantly preferred statement was “choose whole grain products over refined grains/white flour products whenever you can” indicating a less prescriptive option. Effective messaging in guidelines could consider greater specificity regarding frequency, quantity and quality of foods recommended. This exploratory study suggests an improvement in the adoption and consumption of legumes and whole grains in the Australian diet may be better facilitated through consumer-tested messaging.
Article
Historically, there are inconsistencies in the calculation of whole-grain intake, particularly through use of highly variable whole-grain food definitions. The current study aimed to determine the impact of using a whole-grain food definition on whole-grain intake estimation in Australian and Swedish national cohorts; and investigate impacts on apparent associations with CVD risk factors. This utilised the Australian National Nutrition and Physical Activity Survey 2011-12, the Swedish Riksmaten adults 2010-11, and relevant food composition databases. Whole-grain intakes and associations with CVD risk factors were determined based on consumption of foods complying with the Healthgrain definition (≥30% whole grain (dry weight), more whole than refined grain and meeting accepted standards for ‘healthy foods’ based on local regulations), and compared to absolute whole-grain intake. Compliance of whole-grain containing foods with the Healthgrain definition were low in both Sweden (29 of 155 foods) and Australia (214 of 609 foods). Significant mean differences of up to 24.6g/10MJ/day of whole-grain intake were highlighted using Swedish data. Despite these large differences, application of a whole-grain food definition altered very few associations with CVD risk factors. Specifically, changes with body weight and blood glucose associations in Australian adults where a whole-grain food definition was applied, and some anthropometric measures in Swedish data where a high percentage of whole-grain content was included. Use of whole-grain food definitions appear to have limited impact on measuring whole-grain health benefits but may have greater relevance in public health messaging.
Article
Full-text available
Objective: The purpose of this study is to review the effectiveness of the role of whole grain as a therapeutic agent in type 2 diabetes, cardiovascular disease, cancer, and obesity. Methods: An umbrella review of all published meta-analyses was performed. A PubMed search from January 1, 1980, to May 31, 2016, was conducted using the following search strategy: (whole grain OR whole grains) AND (meta-analysis OR systematic review). Only English language publications that provided quantitative statistical analysis on type 2 diabetes, cardiovascular disease, cancer, and weight loss were retrieved. Results: Twenty-one meta-analyses were retrieved for inclusion in this umbrella review, and all the meta-analyses reported statistically significant positive benefits for reducing the incidence of type 2 diabetes (relative risk [RR] = 0.68-0.80), cardiovascular disease (RR = 0.63-0.79), and colorectal, pancreatic, and gastric cancers (RR = 0.57-0.94) and a modest effect on body weight, waist circumference, and body fat mass. Significant reductions in cardiovascular and cancer mortality were also observed (RR = 0.82 and 0.89, respectively). Some problems of heterogeneity, publication bias, and quality assessment were found among the studies. Conclusion: This review suggests that there is some evidence for dietary whole grain intake to be beneficial in the prevention of type 2 diabetes, cardiovascular disease, and colorectal, pancreatic, and gastric cancers. The potential benefits of these findings suggest that the consumption of 2 to 3 servings per day (~45 g) of whole grains may be a justifiable public health goal.
Article
Full-text available
Objective To quantify global intakes of key foods related to non-communicable diseases in adults by region (n=21), country (n=187), age and sex, in 1990 and 2010. Design We searched and obtained individual-level intake data in 16 age/sex groups worldwide from 266 surveys across 113 countries. We combined these data with food balance sheets available in all nations and years. A hierarchical Bayesian model estimated mean food intake and associated uncertainty for each age-sex-country-year stratum, accounting for differences in intakes versus availability, survey methods and representativeness, and sampling and modelling uncertainty. Setting/population Global adult population, by age, sex, country and time. Results In 2010, global fruit intake was 81.3 g/day (95% uncertainty interval 78.9–83.7), with country-specific intakes ranging from 19.2–325.1 g/day; in only 2 countries (representing 0.4% of the world's population), mean intakes met recommended targets of ≥300 g/day. Country-specific vegetable intake ranged from 34.6–493.1 g/day (global mean=208.8 g/day); corresponding values for nuts/seeds were 0.2–152.7 g/day (8.9 g/day); for whole grains, 1.3–334.3 g/day (38.4 g/day); for seafood, 6.0–87.6 g/day (27.9 g/day); for red meats, 3.0–124.2 g/day (41.8 g/day); and for processed meats, 2.5–66.1 g/day (13.7 g/day). Mean national intakes met recommended targets in countries representing 0.4% of the global population for vegetables (≥400 g/day); 9.6% for nuts/seeds (≥4 (28.35 g) servings/week); 7.6% for whole grains (≥2.5 (50 g) servings/day); 4.4% for seafood (≥3.5 (100 g) servings/week); 20.3% for red meats (≤1 (100 g) serving/week); and 38.5% for processed meats (≤1 (50 g) serving/week). Intakes of healthful foods were generally higher and of less healthful foods generally lower at older ages. Intakes were generally similar by sex. Vegetable, seafood and processed meat intakes were stable over time; fruits, nuts/seeds and red meat, increased; and whole grains, decreased. Conclusions These global dietary data by nation, age and sex identify key challenges and opportunities for optimising diets, informing policies and priorities for improving global health.
Article
Full-text available
To investigate the association between intake of dietary fibre and whole grains and risk of colorectal cancer. Systematic review and meta-analysis of prospective observational studies. PubMed and several other databases up to December 2010 and the reference lists of studies included in the analysis as well as those listed in published meta-analyses. Prospective cohort and nested case-control studies of dietary fibre or whole grain intake and incidence of colorectal cancer. 25 prospective studies were included in the analysis. The summary relative risk of developing colorectal cancer for 10 g daily of total dietary fibre (16 studies) was 0.90 (95% confidence interval 0.86 to 0.94, I(2) = 0%), for fruit fibre (n = 9) was 0.93 (0.82 to 1.05, I(2) = 23%), for vegetable fibre (n = 9) was 0.98 (0.91 to 1.06, I(2) = 0%), for legume fibre (n = 4) was 0.62 (0.27 to 1.42, I(2) = 58%), and for cereal fibre (n = 8) was 0.90 (0.83 to 0.97, I(2) = 0%). The summary relative risk for an increment of three servings daily of whole grains (n = 6) was 0.83 (0.78 to 0.89, I(2) = 18%). A high intake of dietary fibre, in particular cereal fibre and whole grains, was associated with a reduced risk of colorectal cancer. Further studies should report more detailed results, including those for subtypes of fibre and be stratified by other risk factors to rule out residual confounding. Further assessment of the impact of measurement errors on the risk estimates is also warranted.
Article
Objective: To quantify the dose-response relation between consumption of whole grain and specific types of grains and the risk of cardiovascular disease, total cancer, and all cause and cause specific mortality. Data sources: PubMed and Embase searched up to 3 April 2016. Study selection: Prospective studies reporting adjusted relative risk estimates for the association between intake of whole grains or specific types of grains and cardiovascular disease, total cancer, all cause or cause specific mortality. Data synthesis: Summary relative risks and 95% confidence intervals calculated with a random effects model. Results: 45 studies (64 publications) were included. The summary relative risks per 90 g/day increase in whole grain intake (90 g is equivalent to three servings-for example, two slices of bread and one bowl of cereal or one and a half pieces of pita bread made from whole grains) was 0.81 (95% confidence interval 0.75 to 0.87; I(2)=9%, n=7 studies) for coronary heart disease, 0.88 (0.75 to 1.03; I(2)=56%, n=6) for stroke, and 0.78 (0.73 to 0.85; I(2)=40%, n=10) for cardiovascular disease, with similar results when studies were stratified by whether the outcome was incidence or mortality. The relative risks for morality were 0.85 (0.80 to 0.91; I(2)=37%, n=6) for total cancer, 0.83 (0.77 to 0.90; I(2)=83%, n=11) for all causes, 0.78 (0.70 to 0.87; I(2)=0%, n=4) for respiratory disease, 0.49 (0.23 to 1.05; I(2)=85%, n=4) for diabetes, 0.74 (0.56 to 0.96; I(2)=0%, n=3) for infectious diseases, 1.15 (0.66 to 2.02; I(2)=79%, n=2) for diseases of the nervous system disease, and 0.78 (0.75 to 0.82; I(2)=0%, n=5) for all non-cardiovascular, non-cancer causes. Reductions in risk were observed up to an intake of 210-225 g/day (seven to seven and a half servings per day) for most of the outcomes. Intakes of specific types of whole grains including whole grain bread, whole grain breakfast cereals, and added bran, as well as total bread and total breakfast cereals were also associated with reduced risks of cardiovascular disease and/or all cause mortality, but there was little evidence of an association with refined grains, white rice, total rice, or total grains. Conclusions: This meta-analysis provides further evidence that whole grain intake is associated with a reduced risk of coronary heart disease, cardiovascular disease, and total cancer, and mortality from all causes, respiratory diseases, infectious diseases, diabetes, and all non-cardiovascular, non-cancer causes. These findings support dietary guidelines that recommend increased intake of whole grain to reduce the risk of chronic diseases and premature mortality.
Udviklingen i danskernes kost
  • S Fagt
  • J Matthiessen
  • A Biltoft-Jensen
  • M V Groth
  • T Christensen
  • H.-J Hinsch
  • H Hartkopp
  • E Trolle
  • N Lyhne
  • A Møller
Fagt, S., Matthiessen, J., Biltoft-Jensen, A., Groth, M. V., Christensen, T., Hinsch, H.-J., Hartkopp, H., Trolle, E., Lyhne, N., and Møller, A. Udviklingen i danskernes kost 1985-2001 [Developments in the Danish dietary intake 1985-2001].
Fuldkornspartnerskabets historie [Danish Whole Grain Partnership's history
  • Fuldkornspartnerskabet
Fuldkornspartnerskabet. Fuldkornspartnerskabets historie [Danish Whole Grain Partnership's history]. Published online at www.fuldkorn.dk/om-partnerskabet/73-historien. Whole Grain Partnership, Copenhagen, Denmark, 2014.
Der er fuld fart på fuldkornsbølgen [A whole grain wave in full speed
  • Fuldkornspartnerskabet
Fuldkornspartnerskabet. Der er fuld fart på fuldkornsbølgen [A whole grain wave in full speed].
Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: A systematic analysis for the Global Burden of Disease Study
GBD 2015 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet. DOI: https://doi.org/10.1016/S0140-6736(16)31679-8. 2016.
Published online at www.fuldkorn.dk/media/179349/the-evolution-of-the-whole-grain-partnership-in-denmark
  • C Greve
  • R I Neess
Greve, C., and Neess, R. I. The evolution of the Whole Grain Partnership in Denmark. Published online at www.fuldkorn.dk/media/179349/the-evolution-of-the-whole-grain-partnership-in-denmark.pdf. Whole Grain Partnership, Copenhagen, Denmark, 2014.
Fuld af korn-En antropologisk undersøgelse af faglaerte og ufaglaerte danskeres hverdagserfaringer med brød og fuldkorn
  • G S Jakobsen
  • A M Jensen
Jakobsen, G. S., and Jensen, A. M. B. Fuld af korn-En antropologisk undersøgelse af faglaerte og ufaglaerte danskeres hverdagserfaringer med brød og fuldkorn [Sociocultural perceptions of whole grain]. Published online at www.fuldkorn.dk/media/69050/fuld-af-korn-antropologisk-studie-2007.pdf. Whole Grain Partnership, Copenhagen, Denmark, 2007.