Effects of an isocaloric healthy Nordic diet on insulin sensitivity,

lipid profile and inflammation markers in metabolic syndrome – a

randomized study (SYSDIET)

Uusitupa M et al. J Intern Med 2013; doi: 10.1111/joim.12044.

Nordic Diet is a diet rich in berries, root vegetables, fish, rye/other whole grains and canola oil

2

Background

• There is ample evidence on benefits of Mediterranean diet on cardiovascular, cognitive and cancer outcomes (Sofi et al. 2010, AJCN). The cardiovascular benefits have not only been demonstrated in prospective cohort studies but also in three large randomized hard endpoint trials (PREDIMED, Lyon Diet Heart and Oslo Diet Heart)

• It’s not known if Nordic Diet, a diet pattern based on berries, cabbages, root vegetables, apple, pear, canola oil, margarine, low fat dairy will lead to similar reductions in cardiovascular risk factors

• Nordic diet pattern has been associated with improved survival in a cross-sectional cohort (Olsen et al. 2011), but it’s effects in metabolic syndrome are unknown

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Methods

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Randomization of participants with metabolic syndrome

n = 200 Nordic dietAt the end; N=96 (7,9 % drop out)

Control diet; high in refined wheat and butterAt the end; N=70 (27 % drop out)

Follow up: 18 or 24 weeks Habitual (usual) diet

Run-in 4 weeks

See next 2 slides for details regarding dietary instructions

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Nordic diet ↑

Control diet ↓

~ 8 small slices of white wheat bread * or similar amount white pasta, buns etc

~ butter or butter-oil spread as only visible fat

* My estimation at the level of 2000 kcal/day, see next slide

Fish minmum 3 timesa week

Canola oil or margarine as only visible fat

≤ 1 fish portions per week

Minimum 500 grams of

berries, fruit and veggies a

day

Maximum 250 grams of

berries, fruit and veggies a

day

Minimum 6 small slices* of high-fiber-bread, brown rice or whole grain pasta daily

Underlined food items were delivered to participants for free

Goals of study diets regarding nutritional values (Supplement online)

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Results

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Baseline values, no significant differences existed

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Biggest changes observed in SFA, PUFA, Fiber, Vit C and beta-carotene intakes

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Changes in food consumption and nutrient intake

• There is no data available on how well participants complied with the instructions regarding specific food items in respective group

• However, the reported intakes of nutrients suggest that participants made major changes in both groups– Intake of fibre, vitamin C and β-carotene was two times higher

during Nordic diet

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Changes in risk factors (1/2)

- Non-HDL cholesterol

- LDL/HDL –ratio

- IL-1Ra (increase was positively associated with SFA & negatively with Mg)

- Apo B/Apo A1 –ratio

– LDL cholesterol– HDL cholesterol– Blood pressure– f-glucose– insulin sensitivity, ie.

Matsuda index– CRP– TNF-α – IL-1β– IL-6– IL-10 – Apo B – Apo A1

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Significant differences between the groups

NO difference betweenthe groups

Changes in risk factors (2/2)

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Discussion

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My speculations

• Nordic diet induced improvement in some lipid parameters and one inflammatory marker (IL-1Ra) when compared to the control diet

• The value of the findings is a matter of debate– Unhealthy control diet was not habitual diet of the participants– Control diet may have been worse than usual diet among the

participants. Oils, margarine, oily fish and whole grains are frequently consumed in Nordic populations

– There was no difference in LDL, nor in HDL cholesterol– There was no difference in CRP, IL-6 or in any other inflammatory

marker beyond IL-1Ra– There were no changes in insulin sensitivity, glucose homeostasis

or blood pressure• Drop out rate was higher in the control group possibly indicating

poor acceptance of unhealthy control diet• The cultural differences in Nordic countries may have impacted

adherence to certain food items

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Aftermath

Page 17

This is how it went.

And this is how it goes with many diet studies

4 Opinion, comment,

blog

3 News2 Press release

1 Scientific paper (article)

All parties add their own spice until conclusions become distorted

Authors presentresults

University sells the story

to media

Media sells the story to

people

Someone further

exaggerates and modifies data/context

Still remember?

The control diet was not habitual, nor conventional diet …

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University of Eastern Finland (press release)

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University of Eastern Finland, press release

Still remember?

LDL and HDL were not different between the diets.

Their combined value LDL/HDL –ratio was different. Also non-HDL

cholesterol was different.

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Lund university, press release

Media: Cholesterol may not be news enough.

“Let’s make it better than Mediterranean diet”

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Finnish media

Finnish media

Still remember?

1. The Mediterranean diet was not part of this study

2. Mediterranean diet is effective in reducing inflammation,

cholesterol, heart attacks, strokes and cancer according to meta-

analyses of prospective cohorts and randomized trials

One rather critical view on the study

National Health Services (NHS), UK*

*Analysis written by Bazian, a company giving ”evidence based support for health care commissioning”

National Health Services (NHS), UK*

I’m fan a of Nordic Diet and enjoy regularly berries, fish, root

vegetables, rye bread and other ”Scandinavian” food items.

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I just think that the study results should be presented as accurately

as possible without rhetoric

Other publications on Nordic diet

1) Adamsson V et al. Effects of a healthy Nordic diet on cardiovascular risk factors in hypercholesterolaemic subjects: a randomized controlled trial (NORDIET). J Intern Med. 2011 Feb;269(2):150-9.

2) Kyrø C et al. Adherence to a healthy Nordic food index is associated with a lower incidence of colorectal cancer in women: the Diet, Cancer and Health cohort study. Br J Nutr. 2013 Mar 14;109(5):920-7

3) Mithril C et al. Guidelines for the New Nordic Diet. Public Health Nutr. 2012 Oct;15(10):1941-7

4) Olsen A et al. Healthy aspects of the Nordic diet are related to lower total mortality. J Nutr. 2011 Apr 1;141(4):639-44

Want to find more recent distorted claims?

Try search words:

“Basu, Lustig sugar is toxic”

“Willet aspartame leukemia”

“Taubes low carbohydrate NuSi”

Page 38

Welcome aboard!

11/04/202339

http://twitter.com/pronutritionisthttp://www.facebook.com/pronutritionisthttp://www.pronutritionist.net (Finnish)

http://www.pronutritionistblog.com (English)

Reijo Laatikainen, Authorized Nutritionist, MBA

Photos: Bigstockphoto and Kotimaiset kasvikset