An Evaluation of Food and Nutrient Intake among Pregnant Women in The Netherlands: A Systematic Review

Nutritional deficiencies during pregnancy can have serious consequences for the health of the (unborn) child. This systematic review provides an updated overview of the available food and nutrient intake data for pregnant women in The Netherlands and an evaluation based on the current recommendations. Embase, MEDLINE, and national institute databases were used. Articles were selected if they had been published since 2008 and contained data on food consumption, nutrient intake, or the status of healthy pregnant women. A qualitative comparison was made with the 2021 Dutch Health Council recommendations and reference values. A total of 218 reports were included, representing 54 individual studies. Dietary assessments were primarily performed via food frequency questionnaires. Protein, vitamin A, thiamin, riboflavin, vitamin B₆, folate, vitamin B₁₂, vitamin C, iron, calcium, and magnesium intakes seemed to be adequate. For folate and vitamin D, supplements were needed to reach the recommended intake. The reasons for concern are the low intakes of fruits, vegetables, and (fatty) fish, and the intakes of alcohol, sugary drinks, and salt. For several foods and nutrients, no or limited intake data were found. High-quality, representative, and recent data are needed to evaluate the nutrient intake of pregnant women in order to make accurate assessments and evaluations, supporting scientific-based advice and national nutritional policies.

Nutri-Score in the European Food Retail Supply: A Potential Incentive for Food Reformulation?

BACKGROUND

To improve consumers' diet, policy measures such as food reformulation strategies and front-of-pack nutritional labels (FOPNLs) are implemented, aiming to guide consumers' food choice and to stimulate an improvement in food composition by manufacturers. The FOPNL Nutri-Score has been implemented in several European countries. Changes in food compositions in relation to the Nutri-Score over time have been limitedly studied. This study evaluates food compositions in Europe over time, and if changes in compositions of the food supply could have potentially resulted in changes in Nutri-Score classifications of foods.

MATERIALS AND METHODS

Food composition data were available from EUREMO, from which bread products, breakfast cereals, hot sauces, and processed potato products from Austria, Belgium, Finland, Italy, and the United Kingdom from 2019 to 2021 were selected (n = 2260). Of these countries, only Belgium had implemented the Nutri-Score in 2019. Distributions of food compositions and Nutri-Score classifications were calculated and changes in median salt, sugar, and saturated fatty acids content were plotted by food group, country and year. Distribution of the final sum of Nutri-Score points was plotted by nutrient, food group, country and year.

RESULTS

Overall, more favourable Nutri-Score classifications (i.e., towards Nutri-Score classification A) were observed in most of the selected food groups and countries over the years, due to the influence of specific nutrients such as salt in breakfast cereals (lower median of 0.1-0.4 g/100 g) and processed potato products (lower median of 0.1-1.2 g/100 g); and sugar in processed potato products (lower median of 0.1-1.9 g/100 g) and bread products (lower median of 0.7-2.2 g/100 g). For nutrient contents in other food groups, no consistent changes were observed.

CONCLUSIONS

Changes in the compositions of the food supply resulted in favourable changes in Nutri-Score classifications, suggesting a potential for food reformulation. Monitoring after the actual implementation of Nutri-Score is recommended.

Organizational Rigidity and Demands: A Qualitative Study on Nursing Work in Complex Organizations

BACKGROUND/OBJECTIVES

The nursing work environment is a critical element in healthcare delivery and a strong predictor of both patient and nurse outcomes. Understanding the complexity and multifaceted nature of this environment is essential for improving nursing practices and optimizing healthcare systems. This study aimed to gain insights into the perceived characteristics of the nursing work environment, considering it as a complex and multifaceted system.

METHODS

A qualitative research approach was employed, involving 42 semi-structured interviews with 43 nurses and managers from academic, teaching, and general hospitals in The Netherlands. Data were collected between July 2020 and August 2021 through convenience sampling. Thematic coding was conducted to identify key patterns and themes.

RESULTS

The findings revealed that nurses demonstrated flexibility and a strong commitment to high-quality care, despite grappling with rigorous organizational tasks and processes. Four key themes emerged: (1) direct patient care as a standard feature of nursing work; (2) nurses' flexibility for hospital productivity; (3) interdependencies, which decrease autonomous nursing practices; and (4) organizational structures that determine how nurses can shape their work. Nurses found it difficult to balance direct care with broader tasks due to organizational rigidity, revealing a gap between ideal nursing practices and daily reality.

CONCLUSIONS

This study highlighted the challenges within the nursing work environment, particularly in balancing direct care with organizational demands. Addressing this gap between ideal nursing practice and reality requires a systems approach. This includes autonomous practices, supportive management, and flexible structures, allowing nurses to shape their work and enhance job satisfaction and care quality.