Abstract
BackgroundThe shape of the associations between intake of foods basic in a healthy Nordic diet and long-term health is not well known. Therefore, we have examined all-cause mortality in a large, prospective cohort of women in Norway in relation to intake of: Nordic fruits and vegetables, fatty fish, lean fish, wholegrain products, and low-fat dairy products.MethodsA total of 83 669 women who completed a food frequency questionnaire between 1996 and 2004 were followed up for mortality until the end of 2018. Cox proportional hazards regression models were used to examine the associations between consumption of the Nordic food groups and all-cause mortality. The Nordic food groups were examined as categorical exposures, and all but wholegrain products also as continuous exposures in restricted cubic spline models.ResultsA total of 8 507 women died during the 20-year follow-up period. Nordic fruits and vegetables, fatty fish and low-fat dairy products were observed to be non-linearly associated with all-cause mortality, while higher intake of lean fish and wholegrain products reduced all-cause mortality. Intake levels and hazard ratios (HR) and 95% confidence intervals (CI) associated with lowest mortality were approximately 200 g/day of Nordic fruits and vegetables (HR 0.83 (95% CI: 0.77–0.91)), 10–20 g/day of fatty fish (10 g/day: HR 0.98 (95% CI: 0.94–1.02)) and 200 g/day of low-fat dairy products (HR 0.96 (95% CI: 0.81–1.01)) compared to no consumption. Consumption of fatty fish ≥ 60 g/day compared to no intake statistically significantly increased the mortality (60 g/day: HR 1.08 (95% CI: 1.01–1.16)), as did consumption of low-fat dairy products ≥ 800 g/day compared to no intake (800 g/day: HR 1.10 (95% CI: 1.02–1.20)). After stratification by smoking status, the observed association between Nordic fruits and vegetables and all-cause mortality was stronger in ever smokers.ConclusionThe associations between intake of foods basic in healthy Nordic diets and all-cause mortality may be non-linear. Therefore, assumptions of linear associations between traditional Nordic food groups and health outcomes could lead to wrong conclusions in analyses of healthy Nordic diets.
Highlights
The shape of the associations between intake of foods basic in a healthy Nordic diet and long-term health is not well known
We have considered consumption of five traditional Nordic food groups as exposure of interest, selected to reflect components of a healthy Nordic diet [1, 2]; Nordic fruits and vegetables; fatty fish classified as fish with ≥ 4% fat in the meat; lean fish containing < 4% fat in the meat excluding products like fish cakes, fish balls, fish spread and stew; wholegrain products; low-fat dairy products
We observed a J-shaped trend between intake of Nordic fruits and vegetables, fatty fish and low-fat dairy products and all-cause mortality, implying that with increasing intake of some traditional Nordic food groups, mortality might change in a non-linear fashion
Summary
The shape of the associations between intake of foods basic in a healthy Nordic diet and long-term health is not well known. Enget Jensen et al BMC Public Health (2022) 22:169 described as dietary patterns with emphasis on foods that have traditionally been used and cultivated in the Nordic region, such as fish, wholegrains like rye and oats, root vegetables, cabbages, fruits like apples and pears, rapeseed oil and, to a varying degree, including low-fat dairy products [1, 2]. In a previous study on healthy Nordic diet and mortality by Olsen et al, it was concluded that traditional Nordic foods should be considered in public health recommendations [1]. Optimal intake levels of traditional Nordic foods, and the ideal composition of healthy Nordic diets for long-term health are, uncertain. The evidence is, not conclusive [9,10,11,12]
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