European Journal of Nutrition

, Volume 53, Issue 4, pp 1123–1134 | Cite as

Effects of a healthy Nordic diet on plasma 25-hydroxyvitamin D concentration in subjects with metabolic syndrome: a randomized, placebo-controlled trial (SYSDIET)

  • Lea BraderEmail author
  • Lars Rejnmark
  • Carsten Carlberg
  • Ursula Schwab
  • Marjukka Kolehmainen
  • Fredrik Rosqvist
  • Lieselotte Cloetens
  • Mona Landin-Olsson
  • Ingibjorg Gunnarsdottir
  • Kaisa S. Poutanen
  • Karl-Heinz Herzig
  • Ulf Risérus
  • Markku J. Savolainen
  • Inga Thorsdottir
  • Matti Uusitupa
  • Kjeld Hermansen
Original Contribution



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.


Vitamin D 25-hydroxyvitamin D Healthy Nordic diet Nordic nutrition recommendations Metabolic syndrome 



25-Hydroxyvitamin D


Body mass index


Docosahexaenoic acids


Eicosapentaenoic acids


Metabolic syndrome


Monounsaturated fatty acids


Nordic nutrition recommendations


Parathyroid hormone


Polyunsaturated fatty acids


Regression coefficient


Standard deviation



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.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Lea Brader
    • 1
    Email author
  • Lars Rejnmark
    • 1
  • Carsten Carlberg
    • 2
  • Ursula Schwab
    • 3
  • Marjukka Kolehmainen
    • 3
  • Fredrik Rosqvist
    • 4
  • Lieselotte Cloetens
    • 5
  • Mona Landin-Olsson
    • 6
  • Ingibjorg Gunnarsdottir
    • 7
  • Kaisa S. Poutanen
    • 3
  • Karl-Heinz Herzig
    • 8
    • 9
  • Ulf Risérus
    • 4
  • Markku J. Savolainen
    • 10
    • 11
  • Inga Thorsdottir
    • 7
  • Matti Uusitupa
    • 3
  • Kjeld Hermansen
    • 1
  1. 1.Department of Endocrinology and Internal MedicineAarhus University HospitalÅrhus CDenmark
  2. 2.Institute of BiomedicineUniversity of Eastern FinlandKuopioFinland
  3. 3.Institute of Public Health and Clinical NutritionUniversity of Eastern FinlandKuopioFinland
  4. 4.Department of Public Health and Caring Sciences, Clinical Nutrition and MetabolismUppsala UniversityUppsalaSweden
  5. 5.Biomedical Nutrition, Pure and Applied BiochemistryLund UniversityLundSweden
  6. 6.Department of EndocrinologySkåne University HospitalLundSweden
  7. 7.Unit for Nutrition Research, Landspitali - The National University of Iceland, Faculty of Food Science and Nutrition, School of Health SciencesUniversity of IcelandReykjavíkIceland
  8. 8.Department of Physiology and Biocenter of Oulu, Institute of BiomedicineOulu UniversityOuluFinland
  9. 9.Medical Research Centre OuluOulu University HospitalOuluFinland
  10. 10.Department of Internal Medicine and Biocenter, Institute of Clinical MedicineUniversity of OuluOuluFinland
  11. 11.Clinical Research CentreOulu University HospitalOuluFinland

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