Effects of a healthy Nordic diet on plasma 25-hydroxyvitamin D concentration in subjects with metabolic syndrome: a randomized, placebo-controlled trial (SYSDIET)
- 552 Downloads
At northern latitudes, vitamin D is not synthesized endogenously during winter, causing low plasma 25-hydroxyvitamin D (25(OH)D) concentrations. Therefore, we evaluated the effects of a healthy Nordic diet based on Nordic nutrition recommendations (NNR) on plasma 25(OH)D and explored its dietary predictors.
In a Nordic multi-centre trial, subjects (n = 213) with metabolic syndrome were randomized to a control or a healthy Nordic diet favouring fish (≥300 g/week, including ≥200 g/week fatty fish), whole-grain products, berries, fruits, vegetables, rapeseed oil and low-fat dairy products. Plasma 25(OH)D and parathyroid hormone were analysed before and after 18- to 24-week intervention.
At baseline, 45 % had vitamin D inadequacy (<50 nmol/l), whereas 8 % had deficiency (<25 nmol/l). Dietary vitamin D intake was increased by the healthy Nordic diet (P < 0.001). The healthy Nordic and the control diet reduced the prevalence of vitamin D inadequacy by 42 % (P < 0.001) and 19 % (P = 0.002), respectively, without between-group difference (P = 0.142). Compared with control, plasma 25(OH)D (P = 0.208) and parathyroid hormone (P = 0.207) were not altered by the healthy Nordic diet. Predictors for 25(OH)D were intake of vitamin D, eicosapentaenoic acids (EPA), docosahexaenoic acids (DHA), vitamin D supplement, plasma EPA and plasma DHA. Nevertheless, only vitamin D intake and season predicted the 25(OH)D changes.
Consuming a healthy Nordic diet based on NNR increased vitamin D intake but not plasma 25(OH)D concentration. The reason why fish consumption did not improve vitamin D status might be that many fish are farmed and might contain little vitamin D or that frying fish may result in vitamin D extraction. Additional ways to improve vitamin D status in Nordic countries may be needed.
KeywordsVitamin D 25-hydroxyvitamin D Healthy Nordic diet Nordic nutrition recommendations Metabolic syndrome
Body mass index
Monounsaturated fatty acids
Nordic nutrition recommendations
Polyunsaturated fatty acids
This work was supported by NordForsk NCoE in Food Nutrition and Health: Project 070014 SYSDIET (Systems biology in controlled dietary interventions and cohort studies) and by the Academy of Finland, Finnish Diabetes Research Foundation, Finnish Foundation for Cardiovascular Research, The Sigrid Juselius Foundation and EVO funding from Kuopio University Hospital (Finland); the Druvan Foundation, ESPEN and Skåne University Hospital, The Heart–Lung Foundation, Diabetesfonden and Foundation Cerealia (Sweden); The Danish Council for Strategic Research (DairyHealth, BioFunCarb), Aarhus University (Denmark), The Agricultural Productivity Fund (Iceland) and the Icelandic Research Fund for graduate students (1206880061). The following companies provided foods for the study participants: Kesko Food Ltd., Raisio Group (Finland); Belico Food AB, Fazer Bageri Sverige, Lantmännen, Oatly AB, Olle Svensson AB, Procordia Food AB, Pågen AB, Unilever, Wasabröd AB (Sweden); Lantmännen Food R&D, Jan Import A/S, Ardo A/S, Scandic Food A/S, WASA, Glyngøre Limfjord A/S, Royal Greenland A/S, Arla Foods (Denmark); The Mother Earth Farm at Vallanes (Iceland), and Unilever Nordic (Sweden, Denmark, Iceland). The companies had no influence on design, implementation, analysis or interpretation of the data.
Conflict of interest
The authors declare that they have no conflict of interest.
- 6.Vimaleswaran KS, Berry DJ, Lu C, Tikkanen E, Pilz S, Hiraki LT, Cooper JD, Dastani Z, Li R, Houston DK, Wood AR, Michaelsson K, Vandenput L, Zgaga L, Yerges-Armstrong LM, McCarthy MI, Dupuis J, Kaakinen M, Kleber ME, Jameson K, Arden N, Raitakari O, Viikari J, Lohman KK, Ferrucci L, Melhus H, Ingelsson E, Byberg L, Lind L, Lorentzon M, Salomaa V, Campbell H, Dunlop M, Mitchell BD, Herzig KH, Pouta A, Hartikainen AL, Streeten EA, Theodoratou E, Jula A, Wareham NJ, Ohlsson C, Frayling TM, Kritchevsky SB, Spector TD, Richards JB, Lehtimaki T, Ouwehand WH, Kraft P, Cooper C, Marz W, Power C, Loos RJ, Wang TJ, Jarvelin MR, Whittaker JC, Hingorani AD, Hypponen E (2013) Causal relationship between obesity and vitamin D status: bi-directional Mendelian randomization analysis of multiple cohorts. PLoS Med 10:e1001383CrossRefGoogle Scholar
- 7.Fung GJ, Steffen LM, Zhou X, Harnack L, Tang W, Lutsey PL, Loria CM, Reis JP, Van Horn LV (2012) Vitamin D intake is inversely related to risk of developing metabolic syndrome in African American and white men and women over 20 y: the Coronary Artery Risk Development in Young Adults study. Am J Clin Nutr 96:24–29CrossRefGoogle Scholar
- 11.Holick MF (2004) Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr 80:1678S–1688SGoogle Scholar
- 12.Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B (2006) Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr 84:18–28Google Scholar
- 14.Bogh MK (2012) Vitamin D production after UVB: aspects of UV-related and personal factors. Scand J Clin Lab Invest Suppl 243:24–31Google Scholar
- 15.Holick MF (1995) Environmental factors that influence the cutaneous production of vitamin D. Am J Clin Nutr 61:638S–645SGoogle Scholar
- 17.Becker W, Lyhne N, Pedersen A, Aro A, Fogelholm M, Thórsdottir I (2004) Nordic nutrition recommendations 2004. Integrating nutrition and physical activity. Nordic Council of Ministers, CopenhagenGoogle Scholar
- 18.Adamsson V, Reumark A, Cederholm T, Vessby B, Riserus U, Johansson G (2012) What is a healthy Nordic diet? Foods and nutrients in the NORDIET study. Food Nutr Res 56. doi: 10.3402/fnr.v56i0.18189
- 22.Uusitupa M, Hermansen K, Savolainen MJ, Schwab U, Kolehmainen M, Brader L, Mortensen LS, Cloetens L, Johansson-Persson A, Onning G, Landin-Olsson M, Herzig KH, Hukkanen J, Rosqvist F, Iggman D, Paananen J, Pulkki KJ, Siloaho M, Dragsted L, Barri T, Overvad K, Bach Knudsen KE, Hedemann MS, Arner P, Dahlman I, Borge G, Baardseth P, Ulven SM, Gunnarsdottir I, Jonsdottir S, Thorsdottir I, Oresic M, Poutanen KS, Riserus U, Akesson B (2013) Effects of an isocaloric healthy Nordic diet on insulin sensitivity, lipid profile and inflammation markers in metabolic syndrome—a randomized study (SYSDIET). J Intern Med. doi: 10.1111/joim.12044 Google Scholar
- 24.Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith SC Jr (2009) Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 120:1640–1645CrossRefGoogle Scholar
- 25.Knudsen VK, Fagt S, Trolle E, Matthiessen J, Groth MV, Biltoft-Jensen A, Sorensen MR, Pedersen AN (2012) Evaluation of dietary intake in Danish adults by means of an index based on food-based dietary guidelines. Food Nutr Res 56. doi: 10.3402/fnr.v56i0.17129
- 26.Bingham SA, Gill C, Welch A, Cassidy A, Runswick SA, Oakes S, Lubin R, Thurnham DI, Key TJ, Roe L, Khaw KT, Day NE (1997) Validation of dietary assessment methods in the UK arm of EPIC using weighed records, and 24-hour urinary nitrogen and potassium and serum vitamin C and carotenoids as biomarkers. Int J Epidemiol 26(Suppl 1):S137–S151CrossRefGoogle Scholar
- 28.Lindberg M, Midthjell K, Bjerve KS (2012) Long-term tracking of plasma phospholipid fatty acid concentrations and their correlation with the dietary intake of marine foods in newly diagnosed diabetic patients: results from a follow-up of the HUNT Study, Norway. Br J Nutr 109(6):1123–1134CrossRefGoogle Scholar
- 31.Boberg M, Croon LB, Gustafsson IB, Vessby B (1985) Platelet fatty acid composition in relation to fatty acid composition in plasma and to serum lipoprotein lipids in healthy subjects with special reference to the linoleic acid pathway. Clin Sci (Lond) 68:581–587Google Scholar
- 34.Brustad M, Alsaker E, Engelsen O, Aksnes L, Lund E (2004) Vitamin D status of middle-aged women at 65–71 degrees N in relation to dietary intake and exposure to ultraviolet radiation. Public Health Nutr 7:327–335Google Scholar
- 38.Heaney RP, Davies KM, Chen TC, Holick MF, Barger-Lux MJ (2003) Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr 77:204–210Google Scholar
- 39.Vieth R, Bischoff-Ferrari H, Boucher BJ, Dawson-Hughes B, Garland CF, Heaney RP, Holick MF, Hollis BW, Lamberg-Allardt C, McGrath JJ, Norman AW, Scragg R, Whiting SJ, Willett WC, Zittermann A (2007) The urgent need to recommend an intake of vitamin D that is effective. Am J Clin Nutr 85:649–650Google Scholar
- 40.Institute of Medicine (2011) Dietary reference intakes for calcium and vitamin D. National Academies Press, Washington, DCGoogle Scholar
- 42.Freisling H, Fahey MT, Moskal A, Ocke MC, Ferrari P, Jenab M, Norat T, Naska A, Welch AA, Navarro C, Schulz M, Wirfalt E, Casagrande C, Amiano P, Ardanaz E, Parr C, Engeset D, Grioni S, Sera F, Bueno-de-Mesquita B, van der Schouw YT, Touvier M, Boutron-Ruault MC, Halkjaer J, Dahm CC, Khaw KT, Crowe F, Linseisen J, Kroger J, Huybrechts I, Deharveng G, Manjer J, Agren A, Trichopoulou A, Tsiotas K, Riboli E, Bingham S, Slimani N (2010) Region-specific nutrient intake patterns exhibit a geographical gradient within and between European countries. J Nutr 140:1280–1286CrossRefGoogle Scholar
- 44.Macdonald HM, Mavroeidi A, Fraser WD, Darling AL, Black AJ, Aucott L, O’Neill F, Hart K, Berry JL, Lanham-New SA, Reid DM (2011) Sunlight and dietary contributions to the seasonal vitamin D status of cohorts of healthy postmenopausal women living at northerly latitudes: a major cause for concern? Osteoporos Int 22:2461–2472CrossRefGoogle Scholar
- 47.Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP (2007) Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr 85:1586–1591Google Scholar
- 50.LaCroix AZ, Kotchen J, Anderson G, Brzyski R, Cauley JA, Cummings SR, Gass M, Johnson KC, Ko M, Larson J, Manson JE, Stefanick ML, Wactawski-Wende J (2009) Calcium plus vitamin D supplementation and mortality in postmenopausal women: the Women’s Health Initiative calcium-vitamin D randomized controlled trial. J Gerontol A Biol Sci Med Sci 64:559–567CrossRefGoogle Scholar
- 51.Margolis KL, Ray RM, Van HL, Manson JE, Allison MA, Black HR, Beresford SA, Connelly SA, Curb JD, Grimm RH Jr, Kotchen TA, Kuller LH, Wassertheil-Smoller S, Thomson CA, Torner JC (2008) Effect of calcium and vitamin D supplementation on blood pressure: the Women’s Health Initiative Randomized Trial. Hypertension 52:847–855CrossRefGoogle Scholar
- 54.Tripkovic L, Lambert H, Hart K, Smith CP, Bucca G, Penson S, Chope G, Hypponen E, Berry J, Vieth R, Lanham-New S (2012) Comparison of vitamin D2 and vitamin D3 supplementation in raising serum 25-hydroxyvitamin D status: a systematic review and meta-analysis. Am J Clin Nutr 95:1357–1364CrossRefGoogle Scholar
- 55.Jones G (2012) Metabolism and biomarkers of vitamin D. Scand J Clin Lab Invest Suppl 243:7–13Google Scholar