Long-term adherence to the New Nordic Diet and the effects on body weight, anthropometry and blood pressure: a 12-month follow-up study

Abstract

Purpose

The New Nordic Diet (NND) has induced weight loss in a 26-week controlled intervention. We aim to investigate whether high compliance and satisfaction can be maintained after the active intervention is discontinued thereby maintaining the health effects.

Methods

After 26 weeks of intervention with NND or Average Danish Diet (ADD), 147 participants (mean age 43 years and mean BMI 29.1 kg/m2) were followed for further 52 weeks. All participants were encouraged to follow NND but without further guidance. The study is registered with ClinicalTrials.gov, study id NCT01195610.

Results

One hundred and ten participants (75 %) completed the follow-up. Among participants previously randomised to NND (NND group), dietary compliance and satisfaction decreased from 4.3 to 3.0 and from 4.8 to 4.0, respectively (both p < 0.0001) (1–5 point scale). Among those originally randomised to ADD (ADD group), satisfaction with NND was significantly higher than with ADD during follow-up (3.3 vs. 2.5, p = 0.026). Weight losses during intervention of −6.2 kg and −3.0 kg were followed by regains of 4.6 kg (SE 0.5) and 1.1 kg (SE 0.7) for the NND group and ADD group, respectively [adjusted difference; mean (95 % CI): 1.8 kg (0.1–3.4), p = 0.041]. Across diet groups, every 1 score higher in compliance with NND was associated with 0.90 kg less body weight regain (p = 0.026) and those who increased physical activity regained 3.4 kg less compared to those who did not (p < 0.0001).

Conclusions

NND provides higher satisfaction, and body weight regain is reduced with higher compliance with NND and increased physical activity.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2

Abbreviations

ADD:

Average Danish Diet

NND:

New Nordic Diet

References

  1. 1.

    WHO (2009) Global health risks: mortality and burden of disease attributable to selected major risks. World Health Organization, Geneva

    Google Scholar 

  2. 2.

    Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC Jr, Spertus JA, Costa F (2005) Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 112:2735–2752

    Article  Google Scholar 

  3. 3.

    Dansinger ML, Gleason JA, Griffith JL, Selker HP, Schaefer EJ (2005) Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA 293:43–53

    CAS  Article  Google Scholar 

  4. 4.

    Nordmann AJ, Suter-Zimmermann K, Bucher HC, Shai I, Tuttle KR, Estruch R, Briel M (2011) Meta-analysis comparing Mediterranean to low-fat diets for modification of cardiovascular risk factors. Am J Med 124:841–851

    Article  Google Scholar 

  5. 5.

    Esposito K, Kastorini CM, Panagiotakos DB, Giugliano D (2011) Mediterranean diet and weight loss: meta-analysis of randomized controlled trials. Metab Syndr Relat Disord 9:1–12

    Article  Google Scholar 

  6. 6.

    Appel LJ, Champagne CM, Harsha DW, Cooper LS, Obarzanek E, Elmer PJ, Stevens VJ, Vollmer WM, Lin PH, Svetkey LP, Stedman SW, Young DR (2003) Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. JAMA 289:2083–2093

    Google Scholar 

  7. 7.

    Larsen TM, Dalskov SM, van Baak M, Jebb SA, Papadaki A, Pfeiffer AF, Martinez JA, Handjieva-Darlenska T, Kunesova M, Pihlsgard M, Stender S, Holst C, Saris WH, Astrup A (2010) Diets with high or low protein content and glycemic index for weight-loss maintenance. N Engl J Med 363:2102–2113

    CAS  Article  Google Scholar 

  8. 8.

    Hooper L, Abdelhamid A, Moore HJ, Douthwaite W, Skeaff CM, Summerbell CD (2012) Effect of reducing total fat intake on body weight: systematic review and meta-analysis of randomised controlled trials and cohort studies. BMJ 345:e7666

    Article  Google Scholar 

  9. 9.

    Astrup A, Grunwald GK, Melanson EL, Saris WH, Hill JO (2000) The role of low-fat diets in body weight control: a meta-analysis of ad libitum dietary intervention studies. Int J Obes Relat Metab Disord 24:1545–1552

    CAS  Article  Google Scholar 

  10. 10.

    Sacks FM, Bray GA, Carey VJ, Smith SR, Ryan DH, Anton SD, McManus K, Champagne CM, Bishop LM, Laranjo N, Leboff MS, Rood JC, de Jonge L, Greenway FL, Loria CM, Obarzanek E, Williamson DA (2009) Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med 360:859–873

    CAS  Article  Google Scholar 

  11. 11.

    Foster GD, Wyatt HR, Hill JO, McGuckin BG, Brill C, Mohammed BS, Szapary PO, Rader DJ, Edman JS, Klein S (2003) A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med 348:2082–2090

    CAS  Article  Google Scholar 

  12. 12.

    Astrup A, Meinert LT, Harper A (2004) Atkins and other low-carbohydrate diets: hoax or an effective tool for weight loss? Lancet 364:897–899

    Article  Google Scholar 

  13. 13.

    Mithril C, Dragsted LO, Meyer C, Blauert E, Holt MK, Astrup A (2012) Guidelines for the New Nordic Diet. Public Health Nutr 15:1–7

    Article  Google Scholar 

  14. 14.

    Poulsen SK, Due A, Jordy AB, Kiens B, Stark KD, Stender S, Holst C, Astrup A, Larsen TM (2014) The health effect of the New Nordic Diet in adults with increased waist circumference—a 6 month randomized controlled trial. Am J Clin Nutr 99:1–11

    Article  Google Scholar 

  15. 15.

    AdamssonV Reumark A, Fredriksson IB, Hammarstrom E, Vessby B, Johansso G, Riserus U (2011) Effects of a healthy Nordic diet on cardiovascular risk factors in hypercholesterolaemic subjects: a randomized controlled trial NORDIET. J Intern Med 269:150–159

    Article  Google Scholar 

  16. 16.

    Mithril C, Dragsted LO, Meyer C, Tetens I, Biltoft-Jensen A, Astrup A (2013) Dietary composition and nutrient content of the New Nordic Diet. Public Health Nutr 16:777–785

    Article  Google Scholar 

  17. 17.

    Gadbury GL, Coffey CS, Allison DB (2003) Modern statistical methods for handling missing repeated measurements in obesity trial data: beyond LOCF. Obes Rev 4:175–184

    CAS  Article  Google Scholar 

  18. 18.

    Due A, Toubro S, Skov AR, Astrup A (2004) Effect of normal-fat diets, either medium or high in protein, on body weight in overweight subjects: a randomised 1-year trial. Int J Obes Relat Metab Disord 28:1283–1290

    CAS  Article  Google Scholar 

  19. 19.

    Mcauley KA, Smith KJ, Taylor RW, McLay RT, Williams SM, Mann JI (2006) Long-term effects of popular dietary approaches on weight loss and features of insulin resistance. Int J Obes 30:342–349

    CAS  Article  Google Scholar 

  20. 20.

    Elmer PJ, Obarzanek E, Vollmer WM, Simons-Morton D, Stevens VJ, Young DR, Lin PH, Champagne C, Harsha DW, Svetkey LP, Ard J, Brantley PJ, Proschan MA, Erlinger TP, Appel LJ (2006) Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control: 18-month results of a randomized trial. Ann Intern Med 144:485–495

    Article  Google Scholar 

  21. 21.

    Jeffery RW, Wing RR (1995) Long-term effects of interventions for weight-loss using food provision and monetary incentives. J Consul Clin Psychol 63:793–796

    CAS  Article  Google Scholar 

  22. 22.

    Svetkey LP (2008) Comparison of strategies for sustaining weight loss. The weight loss maintenance randomized controlled trial. Am J Health Promot 23:152–153

    Google Scholar 

  23. 23.

    Wing RR, Tate DF, Gorin AA, Raynor HA, Fava JL (2006) A self-regulation program for maintenance of weight loss. N Engl J Med 355:1563–1571

    CAS  Article  Google Scholar 

  24. 24.

    Svetkey LP, Ard JD, Stevens VJ, Loria CM, Young DY, Hollis JF, Appel LJ, Brantley PJ, Kennedy BM, Kumanyika SK, Batch BC, Corsino L, Lien LF, Vollmer WM (2012) Predictors of long-term weight loss in adults with modest initial weight loss, by sex and race. Obesity 20:1820–1828

    Article  Google Scholar 

  25. 25.

    Bartfield JK, Stevens VJ, Jerome GJ, Batch BC, Kennedy BM, Vollmer WM, Harsha D, Appel LJ, Desmond R, Ard JD (2011) Behavioral transitions and weight change patterns within the PREMIER trial. Obesity 19:1609–1615

    Article  Google Scholar 

  26. 26.

    Chandon P, Wansink B (2012) Does food marketing need to make us fat? A review and solutions. Nutr Rev 70:571–593

    Article  Google Scholar 

  27. 27.

    Stevens VJ, Obarzanek E, Cook NR, Lee IM, Appel LJ, Smith WD, Milas NC, Mattfeldt-Beman M, Belden L, Bragg C, Millstone M, Raczynski J, Brewer A, Singh B, Cohen J (2001) Long-term weight loss and changes in blood pressure: results of the trials of hypertension prevention, phase II. Ann Intern Med 134:1–11

    CAS  Article  Google Scholar 

  28. 28.

    Hu FB, Willett WC (2002) Optimal diets for prevention of coronary heart disease. JAMA 288:2569–2578

    CAS  Article  Google Scholar 

  29. 29.

    Anderson JW, Konz EC, Frederich RC, Wood CL (2001) Long-term weight-loss maintenance: a meta-analysis of US studies. Am J Clin Nutr 74:579–584

    CAS  Google Scholar 

  30. 30.

    Astrup A, Rossner S (2000) Lessons from obesity management programmes: greater initial weight loss improves long-term maintenance. Obes Rev 1:17–19

    CAS  Article  Google Scholar 

  31. 31.

    Catenacci VA, Grunwald GK, Ingebrigtsen JP, Jakicic JM, McDermott MD, Phelan S, Wing RR, Hill JO, Wyatt HR (2011) Physical activity patterns using accelerometry in the National Weight Control Registry. Obesity 19:1163–1170

    Article  Google Scholar 

  32. 32.

    McGuire MT, Wing RR, Klem ML, Lang W, Hill JO (1999) What predicts weight regain in a group of successful weight losers? J Consult Clin Psychol 67:177–185

    CAS  Article  Google Scholar 

  33. 33.

    Wing RR, Phelan S (2005) Long-term weight loss maintenance. Am J Clin Nutr 82:222S–225S

    CAS  Google Scholar 

  34. 34.

    Wing RR, Papandonatos G, Fava JL, Gorin AA, Phelan S, McCaffery J, Tate DF (2008) Maintaining large weight losses: the role of behavioral and psychological factors. J Consult Clin Psychol 76:1015–1021

    Article  Google Scholar 

  35. 35.

    Hedrick VE, Dietrich AM, Estabrooks PA, Savla J, Serrano E, Davy BM (2012) Dietary biomarkers: advances, limitations and future directions. Nutr J 11:109

    Article  Google Scholar 

  36. 36.

    Alberti KG, Zimmet P, Shaw J (2005) The metabolic syndrome—a new worldwide definition. Lancet 366:1059–1062

    Article  Google Scholar 

  37. 37.

    Chobanian AV, Bakris GL, Black HR et al (2003) The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA 289:2560–2572

    CAS  Article  Google Scholar 

Download references

Acknowledgments

We thank Bente Kiens and colleagues at Department of Nutrition, Exercise and Sports, University of Copenhagen for developing the physical activity questionnaire and for assistances during analysis of the physical activity data. The Nordea Foundation Denmark funded the study. Local food companies provided foods for the shop. Neither the funder nor the food sponsors had any influence on the study design, data collection, data analysis, data interpretation or the content and submission of this paper.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Sanne Kellebjerg Poulsen.

Additional information

The study is a part of the OPUS project. OPUS is an acronym of the Danish title of the project ‘Optimal well-being, development and health for Danish children through a healthy New Nordic Diet’ and is supported by a grant from the Nordea Foundation, Denmark.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PDF 158 kb)

Supplementary material 2 (PDF 130 kb)

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Poulsen, S.K., Crone, C., Astrup, A. et al. Long-term adherence to the New Nordic Diet and the effects on body weight, anthropometry and blood pressure: a 12-month follow-up study. Eur J Nutr 54, 67–76 (2015). https://doi.org/10.1007/s00394-014-0686-z

Download citation

Keywords

  • New Nordic Diet
  • Dietary intervention
  • Weight loss maintenance
  • Follow-up
  • Compliance