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Massara P, Zurbau A, Glenn AJ, Chiavaroli L, Khan TA, Viguiliouk E, Mejia SB, Comelli EM, Chen V, Schwab U, Risérus U, Uusitupa M, Aas AM, Hermansen K, Thorsdottir I, Rahelić D, Kahleová H, Salas-Salvadó J, Kendall CWC, Sievenpiper JL. Nordic dietary patterns and cardiometabolic outcomes: a systematic review and meta-analysis of prospective cohort studies and randomised controlled trials. Diabetologia 2022; 65:2011-2031. [PMID: 36008559 PMCID: PMC9630197 DOI: 10.1007/s00125-022-05760-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 05/24/2022] [Indexed: 01/11/2023]
Abstract
AIMS/HYPOTHESIS Nordic dietary patterns that are high in healthy traditional Nordic foods may have a role in the prevention and management of diabetes. To inform the update of the EASD clinical practice guidelines for nutrition therapy, we conducted a systematic review and meta-analysis of Nordic dietary patterns and cardiometabolic outcomes. METHODS We searched MEDLINE, EMBASE and The Cochrane Library from inception to 9 March 2021. We included prospective cohort studies and RCTs with a follow-up of ≥1 year and ≥3 weeks, respectively. Two independent reviewers extracted relevant data and assessed the risk of bias (Newcastle-Ottawa Scale and Cochrane risk of bias tool). The primary outcome was total CVD incidence in the prospective cohort studies and LDL-cholesterol in the RCTs. Secondary outcomes in the prospective cohort studies were CVD mortality, CHD incidence and mortality, stroke incidence and mortality, and type 2 diabetes incidence; in the RCTs, secondary outcomes were other established lipid targets (non-HDL-cholesterol, apolipoprotein B, HDL-cholesterol, triglycerides), markers of glycaemic control (HbA1c, fasting glucose, fasting insulin), adiposity (body weight, BMI, waist circumference) and inflammation (C-reactive protein), and blood pressure (systolic and diastolic blood pressure). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of the evidence. RESULTS We included 15 unique prospective cohort studies (n=1,057,176, with 41,708 cardiovascular events and 13,121 diabetes cases) of people with diabetes for the assessment of cardiovascular outcomes or people without diabetes for the assessment of diabetes incidence, and six RCTs (n=717) in people with one or more risk factor for diabetes. In the prospective cohort studies, higher adherence to Nordic dietary patterns was associated with 'small important' reductions in the primary outcome, total CVD incidence (RR for highest vs lowest adherence: 0.93 [95% CI 0.88, 0.99], p=0.01; substantial heterogeneity: I2=88%, pQ<0.001), and similar or greater reductions in the secondary outcomes of CVD mortality and incidence of CHD, stroke and type 2 diabetes (p<0.05). Inverse dose-response gradients were seen for total CVD incidence, CVD mortality and incidence of CHD, stroke and type 2 diabetes (p<0.05). No studies assessed CHD or stroke mortality. In the RCTs, there were small important reductions in LDL-cholesterol (mean difference [MD] -0.26 mmol/l [95% CI -0.52, -0.00], pMD=0.05; substantial heterogeneity: I2=89%, pQ<0.01), and 'small important' or greater reductions in the secondary outcomes of non-HDL-cholesterol, apolipoprotein B, insulin, body weight, BMI and systolic blood pressure (p<0.05). For the other outcomes there were 'trivial' reductions or no effect. The certainty of the evidence was low for total CVD incidence and LDL-cholesterol; moderate to high for CVD mortality, established lipid targets, adiposity markers, glycaemic control, blood pressure and inflammation; and low for all other outcomes, with evidence being downgraded mainly because of imprecision and inconsistency. CONCLUSIONS/INTERPRETATION Adherence to Nordic dietary patterns is associated with generally small important reductions in the risk of major CVD outcomes and diabetes, which are supported by similar reductions in LDL-cholesterol and other intermediate cardiometabolic risk factors. The available evidence provides a generally good indication of the likely benefits of Nordic dietary patterns in people with or at risk for diabetes. REGISTRATION ClinicalTrials.gov NCT04094194. FUNDING Diabetes and Nutrition Study Group of the EASD Clinical Practice.
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Affiliation(s)
- Paraskevi Massara
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Andreea Zurbau
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, ON, Canada
- Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada
| | - Andrea J Glenn
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, ON, Canada
- Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Laura Chiavaroli
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, ON, Canada
- Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada
| | - Tauseef A Khan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, ON, Canada
- Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada
| | - Effie Viguiliouk
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Sonia Blanco Mejia
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, ON, Canada
- Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada
| | - Elena M Comelli
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Joannah and Brian Lawson Centre for Child Nutrition, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Victoria Chen
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ursula Schwab
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland.
| | - Ulf Risérus
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Matti Uusitupa
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Anne-Marie Aas
- Division of Medicine, Department of Clinical Service, Section of Nutrition and Dietetics, Oslo University Hospital, Oslo, Norway
| | - Kjeld Hermansen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Inga Thorsdottir
- Unit for Nutrition Research, Health Science Institute, University of Iceland, Reykjavík, Iceland
- Landspitali - University Hospital of Iceland, Reykjavík, Iceland
| | - Dario Rahelić
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
- Croatian Catholic University School of Medicine, Zagreb, Croatia
- Josip Juraj Strossmayer University School of Medicine, Osijek, Croatia
| | - Hana Kahleová
- Institute for Clinical and Experimental Medicine, Diabetes Centre, Prague, Czech Republic
- Physicians Committee for Responsible Medicine, Washington, DC, USA
| | - Jordi Salas-Salvadó
- Centro de Investigacion Biomedica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Human Nutrition Department, IISPV, Universitat Rovira i Virgili, Reus, Spain
| | - Cyril W C Kendall
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, ON, Canada
- Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, ON, Canada.
- Clinical Nutrition and Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada.
- Joannah and Brian Lawson Centre for Child Nutrition, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.
- Division of Endocrinology and Metabolism, Department of Medicine, St Michael's Hospital, Toronto, ON, Canada.
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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Khalili G, Mirzababaei A, Shiraseb F, Mirzaei K. The relationship between modified Nordic diet and resting metabolic rate among overweight and obese women in Tehran, Iran: A cross-sectional study. Int J Clin Pract 2021; 75:e14946. [PMID: 34606670 DOI: 10.1111/ijcp.14946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/01/2021] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Obesity as a worldwide phenomenon is a multifactorial condition. Healthy diets have effect on obesity-related factors like resting metabolic rate (RMR). In the present study, we investigate the association between adherence to modified Nordic diet and RMR among overweight and obese participants. METHODS We enrolled 404 overweight and obese (BMI ≥ 25 kg/m2 ) women aged 18-48 years in this cross-sectional study. For each participant, anthropometrics measurements, biochemical tests and blood pressure were evaluated. RMR was measured by indirect calorimetry. RMR/kg was also measured. Modified Nordic diet score was measured using a validated 147-item food frequency questionnaire (FFQ). RESULTS Among all participants, the mean and standard deviation (SD) for age and body mass index (BMI) were 36.67 years (SD = 9.10) and 31.26 kg/m2 (SD = 4.29), respectively. There was a significant association between RMR/kg status and age, body mass index (BMI), RMR (P < .001), respiratory quotient (RQ), fat percentage (P = .01), systolic blood pressure (SBP) (P = .03) and diastolic blood pressure (DBP) (P = .04), after adjustment for age, BMI, energy intake and physical activity. Participants with the highest adherence to modified Nordic diet had lower odds of hypometabolic status after adjusting for confounders and it was significant (odds ratio (OR) = 3.15, 95% CI = 0.97-10.15, P = .05). CONCLUSIONS The present results indicate that adherence to modified Nordic diet is associated with lower odds of hypometabolic status in overweight and obese women. However, more studies are needed to confirm our findings.
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Affiliation(s)
- Ghazaleh Khalili
- Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Atieh Mirzababaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Farideh Shiraseb
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Khadijeh Mirzaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Metabolic and Hepatic Effects of Energy-Reduced Anti-Inflammatory Diet in Younger Adults with Obesity. Can J Gastroenterol Hepatol 2021; 2021:6649142. [PMID: 33628758 PMCID: PMC7886596 DOI: 10.1155/2021/6649142] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/14/2020] [Accepted: 01/25/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Associated with epidemics of obesity, nonalcoholic fatty liver disease (NAFLD) is becoming the most prevalent liver disease worldwide. The cornerstone of therapy for NAFLD is lifestyle intervention, mainly focused on weight loss. Significant weight loss results from energy-restricted diets, regardless of macronutrient distribution. An anti-inflammatory diet was related to lower odds of NAFLD among daily alcohol drinkers and individuals with metabolic syndrome. This study aims to evaluate the effect of an energy-reduced anti-inflammatory diet on liver status in younger adults with obesity after a 6-month follow-up. METHODS A two-arm randomized controlled trial surveyed 81 participants' (mean age, 43 years) anthropometric and body composition changes. Metabolic status was determined with glycaemic and lipid status, inflammatory status with hs-CRP, IL-6, and TNF-α, and liver status with liver enzymes, NAFLD-FLS, FLI, and FIB-4 indices. The inflammatory potential of the diet was assessed by the Dietary Inflammatory Index, DII®. RESULTS Energy-restricted anti-inflammatory diet resulted in significant weight loss (-7.1%, p < 0.001), in reducing the visceral adiposity (-22.3%, p < 0.001), metabolic (HOMA-IR, -15.5%; total cholesterol, -5.3%; LDL-C, -4.6%; triglycerides, -12.2%), and inflammatory biomarkers (hs-CRP, -29.5%; IL-6, -18.2%; TNF-α, -34.2%), with significant improvement of liver parameters (NAFLD-FLS, -143.4%; FLI, -14.3%; FIB-4, -2.5%). CONCLUSION The study showed the effectiveness of the anti-inflammatory diet with significant improvement of liver parameters in younger adults with obesity, which may reinforce the effectiveness of nutrition-based lifestyle programs, with an anti-inflammatory dietary approach for the treatment and resolution of NAFLD.
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Ramezani-Jolfaie N, Mohammadi M, Salehi-Abargouei A. Effects of a healthy Nordic diet on weight loss in adults: a systematic review and meta-analysis of randomized controlled clinical trials. Eat Weight Disord 2020; 25:1141-1150. [PMID: 31522379 DOI: 10.1007/s40519-019-00773-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 08/31/2019] [Indexed: 02/07/2023] Open
Abstract
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.
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Affiliation(s)
- Nahid Ramezani-Jolfaie
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Mohammadi
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Amin Salehi-Abargouei
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. .,Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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Zimorovat A, Mohammadi M, Ramezani-Jolfaie N, Salehi-Abargouei A. The healthy Nordic diet for blood glucose control: a systematic review and meta-analysis of randomized controlled clinical trials. Acta Diabetol 2020; 57:1-12. [PMID: 31172295 DOI: 10.1007/s00592-019-01369-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/14/2019] [Indexed: 12/14/2022]
Abstract
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.
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Affiliation(s)
- Alireza Zimorovat
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Mohammadi
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Nahid Ramezani-Jolfaie
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Amin Salehi-Abargouei
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
- Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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