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Prevention of Non Communicable Diseases

Adherence to a modified nordic diet and the risk of cardiovascular events in a non-nordic population: a prospective cohort study

European Journal of Clinical Nutrition volume 77, pages 919–924 (2023)Cite this article

Subjects

Abstract

Background

Even though studies have demonstrated that the Nordic diet is beneficial for cardiovascular disease (CVD) risk factors, it is unknown if this diet is associated with actual CVD cases. So, the aim of this study was to investigate the association between a modified Nordic diet and the risk of CVD in non-Nordic adults.

Methods

In this cohort study, 2918 people who participated in the third phase of the Tehran Lipid and Glucose Study (TLGS) were examined. All participants had no CVD at the beginning of the study, which was monitored until 2018. The Nordic score was calculated using a validated food frequency questionnaire (FFQ). Patients’ medical records were examined for cardiovascular events such as coronary heart disease (CHD), stroke, and mortality from CVD. The Cox proportional hazards model was used to assess the relationship between the Nordic score and the risk of CVD.

Results

During a median follow-up of 10.6 years, 203 subjects experienced cardiovascular events. The third and fourth quartiles of the Nordic score were associated with a 35% (HR: 0.65; 95% CI: 0.45, 0.95) and 60% (HR: 0.40; 95% CI: 0.27 to 0.65) reduced risk of CVD compared to the lowest quartile. Subgroup analyses revealed that a high Nordic score was inversely associated with a lower risk of CVD in adults older than 45 years of age, both sexes, and all BMI categories. Each 1-score increase in cereal consumption was associated with a 24% (HR: 0.76; 95% CI: 0.67 to 0.87) lower risk of CVD; low-fat milk with a 23% (HR: 0.77; 95% CI: 0.68 to 0.87); and fish with a 22% (HR: 0.78; 95% CI: 0.69 to 0.89) lower risk of CVD.

Conclusion

We found that high Nordic score adherence may prevent cardiovascular events in non-Nordic populations. Cereals, fish, and low-fat milk were the primary components of the Nordic diet that indicated an inverse relationship with CVD.

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Fig. 1: Hazard ratio (95% CI) for developing CVD across Nordic score components.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Parvin Mirmiran, Saghar Estaki & Mahdieh Golzarand

  2. Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Parvin Mirmiran

  3. Azad University of Medical Sciences, Tehran, Iran

    Anahita Yadegari

  4. Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Fereidoun Azizi

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Contributions

PM: supervised the project; SE: concept and design of the paper, writing of the manuscript; AY: writing of the manuscript; MG: corresponding author, concept and design of the paper, data analysis and interpretation, and finalization of the paper; FA: supervised the project. All authors approved the final version of the manuscript.

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Correspondence to Mahdieh Golzarand.

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Mirmiran, P., Estaki, S., Yadegari, A. et al. Adherence to a modified nordic diet and the risk of cardiovascular events in a non-nordic population: a prospective cohort study. Eur J Clin Nutr 77, 919–924 (2023). https://doi.org/10.1038/s41430-023-01325-4

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