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

European Journal of Epidemiology volume 30, pages509–517(2015)Cite this article

Abstract

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.

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Acknowledgments

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.

Author information

Affiliations

  1. Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen Ø, Denmark

    Nina Roswall & Anja Olsen

  2. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

    Nina Roswall, Sven Sandin, Hans-Olov Adami & Elisabete Weiderpass

  3. Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden

    Marie Löf

  4. Department of Community Medicine, UiT - The Arctic University of Norway, Tromsö, Norway

    Guri Skeie & Elisabete Weiderpass

  5. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

    Hans-Olov Adami

  6. Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland

    Elisabete Weiderpass

  7. The Cancer Registry of Norway, Oslo, Norway

    Elisabete Weiderpass

Authors
  1. Nina Roswall
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  2. Sven Sandin
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Correspondence to Nina Roswall.

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Roswall, N., Sandin, S., Löf, M. et al. Adherence to the healthy Nordic food index and total and cause-specific mortality among Swedish women. Eur J Epidemiol 30, 509–517 (2015). https://doi.org/10.1007/s10654-015-0021-x

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Keywords

  • Nordic Diet
  • Mortality
  • Cancer
  • Cardiovascular disease
  • Cohort study