Adherence to the healthy Nordic food index, dietary composition, and lifestyle among Swedish women

Nina Roswall; Ulf Eriksson; Sven Sandin; Marie Löf; Anja Olsen; Guri Skeie; Hans-Olov Adami; Elisabete Weiderpass

doi:10.3402/fnr.v59.26336

Nina Roswall Danish Cancer Society Research Center, Copenhagen, Denmark Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
Ulf Eriksson Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
Sven Sandin Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
Marie Löf Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
Anja Olsen Danish Cancer Society Research Center, Copenhagen, Denmark
Guri Skeie Department of Community Medicine, University of Tromsö, The Arctic University of Norway, Tromsö, Norway
Hans-Olov Adami Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
Elisabete Weiderpass Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden Department of Community Medicine, University of Tromsö, The Arctic University of Norway, Tromsö, Norway Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland The Cancer Registry of Norway, Oslo, Norway

DOI: https://doi.org/10.3402/fnr.v59.26336

Keywords: Healthy Nordic diet, Dietary pattern, Nordic Nutrition Recommendations, Cross-sectional study, Lifestyle, Adherence

Abstract

Background: Studies examining diet scores in relation to health outcomes are gaining ground. Thus, control for dietary factors not part of the score, and lifestyle associated with adherence, is required to allow for a causal interpretation of studies on diet scores and health outcomes.

Objective: The study objective is to describe and investigate dietary composition, micronutrient density, lifestyle, socioeconomic factors, and adherence to the Nordic Nutrition Recommendations across groups defined by their level of adherence to a healthy Nordic food index (HNFI). The paper examines both dietary components included in the HNFI as well as dietary components, which are not part of the HNFI, to get a broad picture of the diet.

Design: The study is cross-sectional and conducted in the Swedish Women’s Lifestyle and Health cohort. We included 45,277 women, aged 29–49 years at baseline (1991–1992). The HNFI was defined by six items: wholegrain bread, oatmeal, apples/pears, cabbages, root vegetables and fish/shellfish, using data from a food frequency questionnaire. Proportions, means and standard deviations were calculated in the entire cohort and by adherence groups.

Results: Women scoring high on the HNFI had a higher energy intake, compared to low adherers. They had a higher intake of fiber and a higher micronutrient density (components of the HNFI), but also a higher intake of items not included in the HNFI: red/processed meats, sweets, and potatoes. They were on average more physically active and less likely to smoke.

Conclusions: Adherence to the HNFI was associated with a generally healthier lifestyle and a high intake of health-beneficial components. However, it was also associated with a higher energy intake and a higher intake of foods without proven health benefits. Therefore, future studies on the HNFI and health outcomes should take into account potential confounding of dietary and lifestyle factors associated with the HNFI.

Keywords: healthy Nordic diet; dietary pattern; Nordic Nutrition Recommendations; cross-sectional study; lifestyle; adherence

(Published: 11 March 2015)

Responsible Editor: Anja Biltoft-Jensen, Technical University of Denmark, Denmark.

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