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Sabet JA, Ekman MS, Lundvall AS, Risérus U, Johansson U, Öström Å, Adamsson V, Cao Y, Msghina M, Brummer RJ. Feasibility and Acceptability of a Healthy Nordic Diet Intervention for the Treatment of Depression: A Randomized Controlled Pilot Trial. Nutrients 2021; 13:902. [PMID: 33802181 DOI: 10.3390/nu13030902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 02/08/2023] Open
Abstract
Healthy diet interventions have been shown to improve depressive symptoms, but there is a need for randomized controlled trials (RCTs) that are double blind and investigate biological mechanisms. The primary objectives of this randomized controlled pilot trial were to test the palatability of the meals and the acceptability of the intervention in preparation for an 8-week RCT in the future, which will investigate whether a healthy Nordic diet improves depressive symptoms in individuals with major depressive disorder, and associated biological mechanisms. Depressed (n = 10) and non-depressed (n = 6) women and men were randomized to receive either a healthy Nordic diet (ND) or a control diet (CD) for 8 days. Participants were blinded to their diet allocation and the study hypotheses. Health questionnaires were completed before and after the intervention and, throughout the study, questionnaires assessed participants’ liking for the meals, their sensory properties, adherence, and open-ended feedback. In the ND group, 75% of participants consumed only the provided foods, as instructed, compared to 50% of CD participants. The meals of both diets, on average, received good ratings for liking and sensory properties, though the ND ratings were somewhat higher. Overall, results were positive and informative, indicating that the planned RCT will be feasible and well-accepted, with some proposed modifications.
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Tuomainen M, Kärkkäinen O, Leppänen J, Auriola S, Lehtonen M, Savolainen MJ, Hermansen K, Risérus U, Åkesson B, Thorsdottir I, Kolehmainen M, Uusitupa M, Poutanen K, Schwab U, Hanhineva K. Quantitative assessment of betainized compounds and associations with dietary and metabolic biomarkers in the randomized study of the healthy Nordic diet (SYSDIET). Am J Clin Nutr 2019; 110:1108-1118. [PMID: 31504116 DOI: 10.1093/ajcn/nqz179] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 07/10/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Recently, a group of betainized compounds have been suggested to play a role in health effects in relation to a whole-grain-rich diet. OBJECTIVES The aims of this study were to develop a quantitative mass spectrometric method for selected betainized compounds in human plasma, and to investigate their association with nutrient intake and measures of metabolic health in participants of the SYSDIET study. METHODS The SYSDIET study was a controlled randomized intervention including individuals with metabolic syndrome, where the healthy Nordic diet (HND) group increased intakes of whole grains, canola oil, berries, and fish, whereas the control diet (CD) group consumed low-fiber cereal products, milk fat, and restricted amounts of fish and berries. A quantitative LC combined with triple quadrupole MS method for betainized compounds was developed and applied to fasting plasma samples from baseline (week 0) and the end of the intervention (week 18 or 24). Concentrations of betainized compounds were correlated with intakes of selected nutrients and fiber and measures of metabolic health. RESULTS Pipecolic acid betaine (PAB) concentrations were significantly higher in the HND group than in the CD group (P = 0.00032) at the end of the intervention and correlated directly (P < 0.0001) with intakes of dietary fiber (r = 0.376) and a biomarker related to whole-grain rye intake, namely the ratio of alkylresorcinol C17:0 to C21:0 (r = 0.442). PAB was associated inversely with fasting plasma insulin consistently at the beginning and at the end of the intervention (P < 0.001, r = -0.300; P < 0.01, r = -0.250, respectively), as well as IL-1 receptor antagonist (P < 0.01, r = -0.232 at the beginning; P < 0.01, r = -0.236 at the end) and serum LDL/HDL cholesterol (P < 0.01, r = -0.239 at the beginning; P < 0.01, r = -0.241 at the end). CONCLUSIONS Among adults with the metabolic syndrome, PAB plasma concentrations were associated with fasting insulin, inflammation, and lipids and were significantly increased with adoption of the HND. Further studies are needed to clarify the biological functions of betainized compounds. This trial was registered at clinicaltrials.gov as NCT00992641.
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Affiliation(s)
- Marjo Tuomainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Olli Kärkkäinen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Jukka Leppänen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Seppo Auriola
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,LC-MS Metabolomics Center, Biocenter Kuopio, Kuopio, Finland
| | - Marko Lehtonen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,LC-MS Metabolomics Center, Biocenter Kuopio, Kuopio, Finland
| | - Markku J Savolainen
- Medical Research Center, Department of Internal Medicine, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Kjeld Hermansen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Ulf Risérus
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Björn Åkesson
- Biomedical Nutrition, Pure and Applied Biochemistry, Lund University, Lund, Sweden.,Department of Clinical Nutrition, Skåne University Hospital, Lund, Sweden
| | - Inga Thorsdottir
- Unit for Nutrition Research, University of Iceland and Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Marjukka Kolehmainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Matti Uusitupa
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Kaisa Poutanen
- VTT Technical Research Centre of Finland, Espoo, Finland
| | - Ursula Schwab
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland
| | - Kati Hanhineva
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
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Myhrstad MCW, de Mello VD, Dahlman I, Kolehmainen M, Paananen J, Rundblad A, Carlberg C, Olstad OK, Pihlajamäki J, Holven KB, Hermansen K, Dragsted LO, Gunnarsdottir I, Cloetens L, Storm MU, Åkesson B, Rosqvist F, Hukkanen J, Herzig KH, Risérus U, Thorsdottir I, Poutanen KS, Savolainen MJ, Schwab U, Arner P, Uusitupa M, Ulven SM. Healthy Nordic Diet Modulates the Expression of Genes Related to Mitochondrial Function and Immune Response in Peripheral Blood Mononuclear Cells from Subjects with Metabolic Syndrome-A SYSDIET Sub-Study. Mol Nutr Food Res 2019; 63:e1801405. [PMID: 30964598 DOI: 10.1002/mnfr.201801405] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/20/2019] [Indexed: 01/24/2023]
Abstract
SCOPE To explore the effect of a healthy Nordic diet on the global transcriptome profile in peripheral blood mononuclear cells (PBMCs) of subjects with metabolic syndrome. METHODS AND RESULTS Subjects with metabolic syndrome undergo a 18/24 week randomized intervention study comparing an isocaloric healthy Nordic diet with an average habitual Nordic diet served as control (SYSDIET study). Altogether, 68 participants are included. PBMCs are obtained before and after intervention and total RNA is subjected to global transcriptome analysis. 1302 probe sets are differentially expressed between the diet groups (p-value < 0.05). Twenty-five of these are significantly regulated (FDR q-value < 0.25) and are mainly involved in mitochondrial function, cell growth, and cell adhesion. The list of 1302 regulated probe sets is subjected to functional analyses. Pathways and processes involved in the mitochondrial electron transport chain, immune response, and cell cycle are downregulated in the healthy Nordic diet group. In addition, gene transcripts with common motifs for 42 transcription factors, including NFR1, NFR2, and NF-κB, are downregulated in the healthy Nordic diet group. CONCLUSION These results suggest that benefits of a healthy diet may be mediated by improved mitochondrial function and reduced inflammation.
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Affiliation(s)
- Mari C W Myhrstad
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130, Oslo, Norway
| | - Vanessa D de Mello
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211, Kuopio, Finland
| | - Ingrid Dahlman
- Department of Medicine (H7), Karolinska Institute, 141 86, Stockholm, Sweden
| | - Marjukka Kolehmainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211, Kuopio, Finland
| | - Jussi Paananen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211, Kuopio, Finland
| | - Amanda Rundblad
- Department of Nutrition, Institute for Basic Medical Sciences, University of Oslo, 0316, Oslo, Norway
| | - Carsten Carlberg
- Institute of Biomedicine, University of Eastern Finland, 70211, Kuopio, Finland
| | | | - Jussi Pihlajamäki
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211, Kuopio, Finland.,Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, 70029, Kuopio, Finland
| | - Kirsten B Holven
- Department of Nutrition, Institute for Basic Medical Sciences, University of Oslo, 0316, Oslo, Norway.,Norwegian National Advisory Unit on Familial Hypercholesterolemia, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, 0424, Oslo, Norway
| | - Kjeld Hermansen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, 8200, Aarhus, Denmark
| | - Lars O Dragsted
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, DK-2200 Copenhagen N, Denmark
| | - Ingibjörg Gunnarsdottir
- Unit for Nutrition Research, University of Iceland and Landspitali - The National University Hospital of Iceland, 101, Reykjavík, Iceland
| | - Lieselotte Cloetens
- Biomedical Nutrition, Pure and Applied Biochemistry, Lund University, 221 00, Lund, Sweden
| | - Matilda Ulmius Storm
- Biomedical Nutrition, Pure and Applied Biochemistry, Lund University, 221 00, Lund, Sweden
| | - Björn Åkesson
- Biomedical Nutrition, Pure and Applied Biochemistry, Lund University, 221 00, Lund, Sweden.,Department of Clinical Nutrition, Skåne University Hospital, 221 00, Lund, Sweden
| | - Fredrik Rosqvist
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, 751 22, Uppsala, Sweden
| | - Janne Hukkanen
- Department of Internal Medicine and Biocenter Oulu, University of Oulu, and Medical Research Center, Oulu University Hospital, 90014, Oulu, Finland
| | - Karl-Heinz Herzig
- Institute of Biomedicine and Biocenter of Oulu, University of Oulu, Medical Research Center (MRC) and University Hospital, 90014, Oulu, Finland.,Department of Gastroenterology and Metabolism, Poznań University of Medical Sciences, 10 61-701, Poznań, Poland
| | - Ulf Risérus
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, 751 22, Uppsala, Sweden
| | - Inga Thorsdottir
- Unit for Nutrition Research, University of Iceland and Landspitali - The National University Hospital of Iceland, 101, Reykjavík, Iceland
| | - Kaisa S Poutanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211, Kuopio, Finland.,VTT Technical Research Centre of Finland, 02044 VTT, Espoo, Finland
| | - Markku J Savolainen
- Department of Internal Medicine and Biocenter Oulu, University of Oulu, and Medical Research Center, Oulu University Hospital, 90014, Oulu, Finland
| | - Ursula Schwab
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211, Kuopio, Finland.,Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, 70029, Kuopio, Finland
| | - Peter Arner
- Department of Medicine (H7), Karolinska Institute, 141 86, Stockholm, Sweden
| | - Matti Uusitupa
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211, Kuopio, Finland
| | - Stine M Ulven
- Department of Nutrition, Institute for Basic Medical Sciences, University of Oslo, 0316, Oslo, Norway
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Enget Jensen TM, Braaten T, Jacobsen BK, Barnung RB, Olsen A, Skeie G. Adherence to the Healthy Nordic Food Index in the Norwegian Women and Cancer (NOWAC) cohort. Food Nutr Res 2018; 62:1339. [PMID: 30237757 PMCID: PMC6139480 DOI: 10.29219/fnr.v62.1339] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 07/31/2018] [Accepted: 08/01/2018] [Indexed: 11/25/2022] Open
Abstract
Background High adherence to the Healthy Nordic Food Index has been associated with better health outcomes, but the results have not been consistent. The association between high adherence and higher intake of energy and healthy and less healthy foods has been persistent across countries, highlighting the need to examine potential confounding by energy intake. Objective This study aimed to examine energy-adjusted dietary factors and lifestyle factors related to the index in a Norwegian context. Design The study was cross-sectional within the Norwegian Women and Cancer cohort and included 81,516 women aged 41–76. Information about habitual food intake was based on a food frequency questionnaire (FFQ). The index incorporated six food groups (fish, root vegetables, cabbages, apples/pears, whole grain bread, and breakfast cereals). Ordered trend and regression analyses were performed to assess the association between the index and lifestyle and dietary factors with energy-adjusted models. Results Nearly one out of four women (22.8%) had low adherence, 49.0% had medium adherence, and 28.2% had high adherence to the index. Intake of energy and of both healthy and less healthy foods increased with increased adherence. Energy adjustment removed the associations between less healthy foods and high adherence and demonstrated a better dietary composition in high adherers. The healthy Nordic foods contributed more to the total food intake in high versus low adherers, and high adherence was associated with a healthier lifestyle. Conclusion High adherence was associated with a healthier lifestyle, both concerning diet and other factors. Energy adjustment of potential confounding foods removed associations between high adherence and less healthy foods. The Nordic foods accounted for a larger fraction of the diet among high adherers, at the expense of other healthy foods. Careful adjustment for confounders is warranted when assessing associations between the index and health outcomes.
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Affiliation(s)
- Torill M Enget Jensen
- Department of Community Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Tonje Braaten
- Department of Community Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Bjarne Koster Jacobsen
- Department of Community Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Runa Borgund Barnung
- Department of Community Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Anja Olsen
- Danish Cancer Society Research Center, Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen 2100, Denmark
| | - Guri Skeie
- Department of Community Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
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Roswall N, Eriksson U, Sandin S, Löf M, Olsen A, Skeie G, Adami HO, Weiderpass E. Adherence to the healthy Nordic food index, dietary composition, and lifestyle among Swedish women. Food Nutr Res 2015; 59:26336. [PMID: 25773303 PMCID: PMC4359984 DOI: 10.3402/fnr.v59.26336] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 02/02/2015] [Accepted: 02/10/2015] [Indexed: 12/15/2022] Open
Abstract
Background Studies examining diet scores in relation to health outcomes are gaining ground. Thus, control for dietary factors not part of the score, and lifestyle associated with adherence, is required to allow for a causal interpretation of studies on diet scores and health outcomes. Objective The study objective is to describe and investigate dietary composition, micronutrient density, lifestyle, socioeconomic factors, and adherence to the Nordic Nutrition Recommendations across groups defined by their level of adherence to a healthy Nordic food index (HNFI). The paper examines both dietary components included in the HNFI as well as dietary components, which are not part of the HNFI, to get a broad picture of the diet. Design The study is cross-sectional and conducted in the Swedish Women's Lifestyle and Health cohort. We included 45,277 women, aged 29–49 years at baseline (1991–1992). The HNFI was defined by six items: wholegrain bread, oatmeal, apples/pears, cabbages, root vegetables and fish/shellfish, using data from a food frequency questionnaire. Proportions, means and standard deviations were calculated in the entire cohort and by adherence groups. Results Women scoring high on the HNFI had a higher energy intake, compared to low adherers. They had a higher intake of fiber and a higher micronutrient density (components of the HNFI), but also a higher intake of items not included in the HNFI: red/processed meats, sweets, and potatoes. They were on average more physically active and less likely to smoke. Conclusions Adherence to the HNFI was associated with a generally healthier lifestyle and a high intake of health-beneficial components. However, it was also associated with a higher energy intake and a higher intake of foods without proven health benefits. Therefore, future studies on the HNFI and health outcomes should take into account potential confounding of dietary and lifestyle factors associated with the HNFI.
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Affiliation(s)
- Nina Roswall
- Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden;
| | - Ulf Eriksson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sven Sandin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Marie Löf
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Anja Olsen
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Guri Skeie
- Department of Community Medicine, University of Tromsö, The Arctic University of Norway, Tromsö, Norway
| | - Hans-Olov Adami
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Elisabete Weiderpass
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Community Medicine, University of Tromsö, The Arctic University of Norway, Tromsö, Norway.,Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland.,The Cancer Registry of Norway, Oslo, Norway
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