The New Nordic Diet: phosphorus content and absorption

Association between Baltic sea diet and healthy Nordic diet index with risk of non-alcoholic fatty liver disease: a case-control study

Recent evidence shows the beneficial effects of Baltic Sea diet score (BSDS) and healthy Nordic diet index (HNDI) on chronic diseases, however, there is no evidence to investigate them on the risk of non-alcoholic fatty liver disease (NAFLD). The purpose of this study was to investigate the associations between BSDS and HNDI with the risk of NAFLD. In this case-control study, 552 people in good health and 340 people with NAFLD over the age of 18 took part. The evaluation of BSDS and HNDI employed a validated 168-item semi-quantitative food frequency questionnaire (FFQ). Binary logistic regression was used to determine how OBS and NAFLD are related. The mean BSDS and HNDI were 16.00 ± 2.49 and 11.99 ± 2.61, respectively. The final model's confounder adjustment revealed that greater HNDI adherence scores gave protection against the occurrence of NAFLD (odds ratio [OR]: 0.42; 95% confidence interval [CI] 0.18-0.98; P for trend = 0.043). In addition, those with the highest BSDS scores had significantly lower risks of developing NAFLD compared to subjects with the lowest scores (OR = 0.48, 95% CI 0.32-0.89; p for trend = 0.003). Our findings showed that following a healthy Nordic diet can significantly prevent the risk of developing NAFLD, and suggest that the highly nutritious components of the Nordic diet are beneficial for the prevention of NAFLD.

A Therapeutic Approach in the Management of Chronic Kidney Disease: Plant-Based Dietary Models and Associated Parameters

PURPOSE OF REVIEW

Chronic kidney disease is one of the leading causes of death worldwide today. Nutrition and nutrition-related factors have a very important role in both the prevention and management of the disease. Plant-based dietary practices are one of the promising approaches to chronic kidney disease. This review aims to examine the potential benefits and risks of plant-based diet models on symptoms and indices used in diet quality in chronic kidney disease.

RECENT FINDINGS

Recently, a growing body of evidence has shown that, unlike animal-based diets, diets rich in plant-based nutrients may play an active role in the incidence of chronic kidney disease in many ways and the management of common symptoms, such as metabolic acidosis, uremic toxicity, and hyperphosphatemia. Implementation of existing plant-based dietary patterns in patients with chronic kidney disease may increase the efficacy of the diet and improve patients' quality of life by expanding their food choices. While there are concerns about creatine deficiency, dietary adequacy, and accessibility regarding plant-based diets, available information is limited.

Study protocol: long-term effect of the New Nordic Renal Diet on phosphorus and lipid homeostasis in patients with chronic kidney disease, stages 3 and 4: a randomised controlled trial

INTRODUCTION

Chronic kidney disease (CKD) causes severe disturbances in phosphate metabolism. New Nordic Renal Diet (NNRD) is a new dietary concept designed by the present research group that aims to offer patients with moderate CKD a whole food approach with a markedly reduction in dietary phosphorus intake, corresponding to 850 mg/day. The present protocol describes a randomised controlled trial aiming to test the long-term effects of dietary intervention with NNRD versus a non-restricted habitual diet on important parameters of phosphorus and lipid homeostasis.

METHODS AND ANALYSIS

This trial will be executed at the Department of Nephrology, Rigshospitalet, University of Copenhagen, Denmark. Sixty patients aged >18 years with CKD stages 3 and 4 (estimated glomerular filtration rate between 15 and 45 mL/min) will be recruited and randomly assigned to the intervention or control group. The other inclusion criterion includes a medically stable condition for at least 2 months prior to the start of the study. Exclusion criteria are treatment with phosphate binders, metabolic disorders that require specific dietary regulation, pregnancy and breast feeding, any types of food allergies or those who are vegans. The observation period is 26 weeks including seven study visits at the outpatient clinic combined with a weekly telephone consultation in both groups. A follow-up visit 3 months after study completion finalises the intervention. The primary outcome is the difference in the change in 24-hour urine phosphorus excretion from baseline to week 26 between the two study groups. Secondary outcomes include changes in phosphate-related and lipid metabolism-related blood and urine biochemistry, blood pressure and body composition. Moreover, we wish to explore adherence to the diet as well as quality of life.

ETHICS AND DISSEMINATION

The study has been approved by the Scientific Ethical Committee of the Capital Region of Denmark and the Danish Data Protection Agency. The results of the studies will be presented at national and international scientific meetings, and publications will be submitted to peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov (wwwclinicaltrialsgov) Registry (NCT04579315).

PROTOCOL VERSION

The protocol, version 2, has been approved by the Ethical Committee Denmark on 18 September 2020. The protocol has also been approved by Data Protection Regulation and Data Protection Law on 15 September 2020. This study protocol is in accordance with the Standard Protocol Items: Recommendations for International Trials.

Effects of a healthy Nordic diet on weight loss in adults: a systematic review and meta-analysis of randomized controlled clinical trials

OBJECTIVES

Studies on the effect of the Nordic diet (ND) on body weight and adiposity indices were conflicting. This study targeted to perform a systematic review and meta-analysis of randomized controlled clinical trials (RCTs) examined the effect of the ND on body weight and composition.

METHODS

PubMed, Scopus, ISI web of Science, ProQuest and Google Scholar were searched for the eligible studies up to August 2019. The weighted mean difference (WMD) in body weight and composition indices between the ND and control groups/periods was derived using random-effects model.

RESULTS

In total, seven studies (n = 774 participants) were included in the present study. Five studies had illustrated the effect of the ND on weight, three on waist circumference (WC), two on body fat, and two on body mass index (BMI). The pooled analysis of eligible trials showed that those adhered to the ND lost 1.83 kg [95% confidence interval (CI) - 2.94, - 0.73, P = 0.001] more weight compared to controls. Qualitative assessment of other anthropometric indices also showed a beneficial effect of this dietary pattern in improving body fat and BMI values; however, these findings are not conclusive because of limited number of studies.

CONCLUSION

Adherence to the ND significantly improves body weight; however, there is also no certainty that this diet is effective for improving other anthropometric indices. Future studies regarding the effect of the ND on weight and body composition in populations other than Nordic populations are highly recommended. Level of evidence Level I, systematic reviews and meta-analyses.

Revising Dietary Phosphorus Advice in Chronic Kidney Disease G3-5D

We summarize how practicing dietitians combined available evidence with clinical experience, to define revised dietary recommendations for phosphorus in chronic kidney disease G3-5D. As well as a review of the evidence base, 4 priority topics were reviewed. These were translated into 3 nutrient level recommendations: the introduction of some plant protein where phosphorus is largely bound by phytate; consideration of protein intake in terms of phosphorus load and the phosphorus to protein ratio; and an increased focus on avoiding phosphate additives. This review summarizes and interprets the available evidence in order to support the development of practical food-based advice for patients with chronic kidney disease.

Short-term effect of the New Nordic Renal Diet on phosphorus homoeostasis in chronic kidney disease Stages 3 and 4

BACKGROUND

The New Nordic Diet is a food concept favouring organically produced food items, fruits, vegetables, whole grains and fish. We investigated the short-term effects of a modified phosphorus-reduced New Nordic Renal Diet (NNRD) in chronic kidney disease (CKD) patients on important parameters of phosphorus homoeostasis.

METHODS

The NNRD contained a total of 850 mg phosphorus/day. A total of 18 patients, CKD Stages 3 and 4 were studied in a randomized crossover trial comparing a 1-week control period of the habitual diet with a 1-week period of the NNRD. Data were obtained at baseline and during 1 week of dietary intervention (habitual diet versus NNRD) by collecting fasting blood samples and 24-h urine collections. The primary outcome was the difference in the change in 24-h urine phosphorus excretion from baseline to Day 7 between the NNRD and habitual diet periods. Secondary outcomes were changes in the fractional excretion of phosphorus, fibroblast growth factor 23 (FGF23) and plasma phosphate.

RESULTS

As compared with the habitual diet, 24-h urine phosphorus excretion was reduced in the NNRD by 313 mg/day (P < 0.001). The mean baseline phosphorus was 875 ± 346 mg/day and was decreased by 400 ± 256 mg/day in the NNRD and 87 ± 266 mg/day in the habitual diet. The 24-h urine fractional excretion of phosphorus decreased by 11% (P < 0.001) and FGF23 decreased by 30 pg/mL (P = 0.03) with the NNRD compared with the habitual diet. Plasma phosphate did not change.

CONCLUSION

This study demonstrates that dietary phosphorus restriction in the context of the NNRD is feasible and has positive effects on phosphorus homeostasis in CKD patients.

The healthy Nordic diet for blood glucose control: a systematic review and meta-analysis of randomized controlled clinical trials

AIMS

Investigations on the possible effect of the Nordic diet (ND) on the glycemic control and the risk of diabetes have led to inconsistent results. The present study tried to determine the effect of the ND on the markers of blood glucose control using a systematic review and meta-analysis of randomized controlled clinical trials (RCTs).

METHODS

Predefined keywords were used to search PubMed, ISI Web of Science, Scopus and Google Scholar up to April 2019. The random effects model was used to compute the overall estimates.

RESULTS

In total, six RCTs with 618 participants (6-26 weeks of follow-up period) were included in the present study. The meta-analysis revealed that the ND might not have a considerable effect on fasting blood glucose levels [weighted mean difference (WMD) = -0.05 mmol/l, 95% CI - 0.13, 0.01, P = 0.112]. In contrast, the analyses showed that the ND significantly reduces serum insulin concentrations (WMD = -1.12 mU/l, 95% CI - 1.84, - 0.39, P = 0.002) and the homeostasis model assessment for insulin resistance (HOMA-IR) (WMD = - 0.34, 95% CI - 0.53, - 0.14, P = 0.001) compared to control diets. The effect on serum insulin levels was sensitive to one of the included studies. This dietary pattern did not significantly affect 2-h post-prandial blood glucose and Matsuda index.

CONCLUSIONS

Adherence to the ND might improve serum insulin and HOMA-IR levels; however, this effect was not confirmed for other markers of blood glucose control. Future well-designed and long-term clinical trials are highly recommended.

Influence of a physical exercise until exhaustion in normothermic and hyperthermic conditions on serum, erythrocyte and urinary concentrations of magnesium and phosphorus

AIM

The aim of this study was to evaluate the effect of the performance of a maximal exercise test until exhaustion in normothermic and hyperthermic conditions on body concentrations of magnesium (Mg) and phosphorus (P).

METHODS

19 adult males (age: 22.58 ± 1.05 years) performed two maximum incremental exercise tests on a cycloergometer separated by 48 h. The first was performed in normothermia (22 ± 2 °C) and the second in hyperthermic conditions induced with a sauna (42 ± 2 °C). Blood and urine samples were taken before and after each test.

RESULTS

The tests in hyperthermia did not produce ergospirometric alterations or a noticeable cardiovascular drift. Serum Mg concentrations underwent a reduction after the stress test in hyperthermia (p > 0.05) but not in normothermia. Nevertheless, urinary and erythrocyte concentrations of Mg, and urinary, erythrocyte and serum concentrations of P did not undergo alterations in either conditions.

CONCLUSIONS

It seems that exercise in hyperthermic conditions induces a tissue redistribution of Mg in the body, a fact which was not observed in normothermic conditions.