Changes in healthy eating: a 20-year longitudinal study in Estonia

Katre Sakala
About the Author

Katre Sakala is the project manager of the Estonian Children Personality Behaviour and Health Study (ECPBHS) at the University of Tartu, Estonia.

The topic of adopting healthier diets is increasingly popular due to better awareness of issues like obesity, diet-related health problems and illnesses, and a general pursuit of better life quality. A large, longitudinal study in Estonia investigated how eating patterns have changed over the years, and which factors influence the food choices we make.

The Estonian Children Personality Behaviour and Health Study (ECPBHS) is a multidisciplinary study that has been going on for already 20 years. It started in 1998, when participants were 9 and 15 year-old schoolchildren from Tartu County in Estonia. The 1176 children that were included in the study in 1998 were tested again when they were 18, 25 and 33 year-old.

Through the ECPBHS, we have examined different aspects of both mental and physical health, risky behaviour, physical activity, psychosocial well-being, impulsivity and personality. An additional topic of study has also been nutrition.

To investigate whether the children in the study were eating healthy, we have analysed whether the nutrient and food intake comply with the Estonian dietary recommendations. When we compared our results with the previous studies carried out in Estonia1,2 we discovered that although the deficiency in many nutrient intakes showed fairly unhealthy food habits in Estonian schoolchildren3, there was a shift to a better average energy intake and consumption over time, and especially in comparison to the end of 1980s and the beginning of 1990s4. Throughout the years we have seen the tendency towards healthier food habits, but there is still overconsumption of fats, and the consumption of fibre, as well as some of the vitamins and minerals were below the recommendations3.

We know that the changes in society (including working patterns of men and women)5 can bring changes in the eating patterns and when we looked at the teenagers’ eating habits6, we saw that the role of family was important how teenagers’ eating habits were influenced. Although we saw that 18 year olds in 2001 and in 2007 were eating regularity of three meals a day, there was a shift among boys to have more irregular breakfast consumption in 2007, but also having school-lunch was higher in 2007 than in 2001.

We have also looked at the consumption of fast food and fizzy drinks and discovered that it was affected not only by age, gender, ethnic and urban environment, but it was also affected by mothers’ income and educational level7. We also found that children with certain gene polymorphism (ADRA2A C-1291G) consumed more ready-made sweet food products and sweet sour milk products.8

What is important to remember, is that although our genes, family habits and society affect how we eat, we can still learn to make healthy food choices. So do not forget the basics: eat less sweets, and more vegetables and fruits. Fibres and fats are both important, but again, only to a certain amount. Whatever diet one follows should be balanced, and combined with physical activity. These principles should also be taught to our children, so that they too could enjoy the benefits of a healthier diet and a more active lifestyle. Though, we have seen the tendency towards healthier food habits, there is still a room for improvement. Hopefully, we will see this improvement in our population study in the next few years.


1.) Saava, M., Pauts, V., Tšaiko, L., & Sink, R. (1995). Toitumine ja alimentaarsed ateroskleroosi riskitegurid koolieas Eesti Arst, 4, 319-325.

2.) Grünberg, H., Mitt, K., & Thetloff, M. (1997). Food habits and dietary Intake of schoolchildren in Estonia Scandinavian Journal of Nutrition, 41, 18-22.

3.) Gross, K. (2006). Eesti koolilaste toitainete ja toidugruppide tarbimine (BA thesis). University of Tartu.

4.) Villa, I., Alep, J., & Harro, M. (2002). Eesti koolilaste toitumine viimasel 15 aastal. Eesti Arst, 88(9), 607.

5. ) Mestdag 2005; Lund & Gronow 2014

6.) Jõers-Türn, K. (2015). „Family factors influencing teenagers eating habit“ (MA thesis). University of Tartu.

7.) Alavere, H. (2007). Kiirtoidu ja gaseeritud jookide tarbimine ning seos insuliinresistentsusega Eesti koolilastel (MA thesis). University of Tartu.

8.) Mäestu, J., Villa, I., Parik, J., Paaver, M., Merenäkk,. L., Eensoo, D., Harro, M., & Harro, J. (2007). Human adrenergic α2A receptor C-1291G leads to higher consumption of sweet food products Molecular Psychiatry 12, 520-521.