European Journal of Epidemiology

, Volume 30, Issue 6, pp 509–517 | Cite as

Adherence to the healthy Nordic food index and total and cause-specific mortality among Swedish women

  • Nina RoswallEmail author
  • Sven Sandin
  • Marie Löf
  • Guri Skeie
  • Anja Olsen
  • Hans-Olov Adami
  • Elisabete Weiderpass


Several healthy dietary patterns have been linked to longevity. Recently, a Nordic dietary pattern was associated with a lower overall mortality. No study has, however, investigated this dietary pattern in relation to cause-specific mortality. The aim of the present study was to examine the association between adherence to a healthy Nordic food index (consisting of wholegrain bread, oatmeal, apples/pears, root vegetables, cabbages and fish/shellfish) and overall mortality, and death by cardiovascular disease, cancer, injuries/suicide and other causes. We conducted a prospective analysis in the Swedish Women’s Lifestyle and Health cohort, including 44,961 women, aged 29–49 years, who completed a food frequency questionnaire between 1991–1992, and have been followed up for mortality ever since, through Swedish registries. The median follow-up time is 21.3 years, and mortality rate ratios (MRR) were calculated using Cox Proportional Hazards Models. Compared to women with the lowest index score (0–1 points), those with the highest score (4–6 points) had an 18 % lower overall mortality (MRR 0.82; 0.71–0.93, p < 0.0004). A 1-point increment in the healthy Nordic food index was associated with a significantly lower risk of all-cause mortality: 6 % (3–9 %), cancer mortality: 5 % (1–9 %) and mortality from other causes: 16 % (8–22 %). When examining the diet components individually, only wholegrain bread and apples/pears were significantly inversely associated with all-cause mortality. We observed no effect-modification by smoking status, BMI or age at baseline. The present study encourages adherence to a healthy Nordic food index, and warrants further investigation of the strong association with non-cancer, non-cardiovascular and non-injury/suicide deaths.


Nordic Diet Mortality Cancer Cardiovascular disease Cohort study 



The authors wish to thank data manager Pouran Almstedt for database administration. The present study was supported by a grant from the Swedish Research Council. Grant No. 521-2011-2955.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the regional Ethical Committee at Uppsala University, and the Ethical Committee at Karolinska Institutet, Stockholm.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

10654_2015_21_MOESM1_ESM.docx (16 kb)
Supplementary material 1 (DOCX 15 kb)
10654_2015_21_MOESM2_ESM.docx (15 kb)
Supplementary material 2 (DOCX 14 kb)


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Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  • Nina Roswall
    • 1
    • 2
    Email author
  • Sven Sandin
    • 2
  • Marie Löf
    • 3
  • Guri Skeie
    • 4
  • Anja Olsen
    • 1
  • Hans-Olov Adami
    • 2
    • 5
  • Elisabete Weiderpass
    • 2
    • 4
    • 6
    • 7
  1. 1.Danish Cancer Society Research CenterCopenhagen ØDenmark
  2. 2.Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
  3. 3.Department of Biosciences and NutritionKarolinska InstitutetStockholmSweden
  4. 4.Department of Community MedicineUiT - The Arctic University of NorwayTromsöNorway
  5. 5.Department of EpidemiologyHarvard School of Public HealthBostonUSA
  6. 6.Genetic Epidemiology Group, Folkhälsan Research CenterHelsinkiFinland
  7. 7.The Cancer Registry of NorwayOsloNorway

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