Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Medicine
Published in: BMC Medicine 1/2018

Open Access 01-12-2018 | Research article

Nordic diet, Mediterranean diet, and the risk of chronic diseases: the EPIC-Potsdam study

Authors: Cecilia Galbete, Janine Kröger, Franziska Jannasch, Khalid Iqbal, Lukas Schwingshackl, Carolina Schwedhelm, Cornelia Weikert, Heiner Boeing, Matthias B. Schulze

Published in: BMC Medicine | Issue 1/2018

Login to get access

Abstract

Background

The Mediterranean Diet (MedDiet) has been acknowledged as a healthy diet. However, its relation with risk of major chronic diseases in non-Mediterranean countries is inconclusive. The Nordic diet is proposed as an alternative across Northern Europe, although its associations with the risk of chronic diseases remain controversial. We aimed to investigate the association between the Nordic diet and the MedDiet with the risk of chronic disease (type 2 diabetes (T2D), myocardial infarction (MI), stroke, and cancer) in the EPIC-Potsdam cohort.

Methods

The EPIC-Potsdam cohort recruited 27,548 participants between 1994 and 1998. After exclusion of prevalent cases, we evaluated baseline adherence to a score reflecting the Nordic diet and two MedDiet scores (tMDS, reflecting the traditional MedDiet score, and the MedPyr score, reflecting the MedDiet Pyramid). Cox regression models were applied to examine the association between the diet scores and the incidence of major chronic diseases.

Results

During a follow-up of 10.6 years, 1376 cases of T2D, 312 of MI, 321 of stroke, and 1618 of cancer were identified. The Nordic diet showed a statistically non-significant inverse association with incidence of MI in the overall population and of stroke in men. Adherence to the MedDiet was associated with lower incidence of T2D (HR per 1 SD 0.93, 95% CI 0.88–0.98 for the tMDS score and 0.92, 0.87–0.97 for the MedPyr score). In women, the MedPyr score was also inversely associated with MI. No association was observed for any of the scores with cancer.

Conclusions

In the EPIC-Potsdam cohort, the Nordic diet showed a possible beneficial effect on MI in the overall population and for stroke in men, while both scores reflecting the MedDiet conferred lower risk of T2D in the overall population and of MI in women.
Appendix
Available only for authorised users
Literature
1.
Mithril C, Dragsted LO, Meyer C, Blauert E, Holt MK, Astrup A. Guidelines for the new Nordic diet. Public Health Nutr. 2012;15(10):1941–7.CrossRefPubMed
2.
3.
Hansen CP, Overvad K, Kyro C, Olsen A, Tjonneland A, Johnsen SP, et al. Adherence to a healthy Nordic diet and risk of stroke: a Danish cohort study. Stroke. 2017;48(2):259–64.CrossRefPubMed
4.
Kanerva N, Rissanen H, Knekt P, Havulinna AS, Eriksson JG, Mannisto S. The healthy Nordic diet and incidence of type 2 diabetes--10-year follow-up. Diabetes Res Clin Pract. 2014;106(2):e34–7.CrossRefPubMed
5.
Kyro C, Skeie G, Loft S, Overvad K, Christensen J, Tjonneland A, et al. Adherence to a healthy Nordic food index is associated with a lower incidence of colorectal cancer in women: the diet, Cancer and health cohort study. Br J Nutr. 2013;109(5):920–7.CrossRefPubMed
6.
Lacoppidan SA, Kyro C, Loft S, Helnaes A, Christensen J, Hansen CP, et al. Adherence to a healthy Nordic food index is associated with a lower risk of Type-2 diabetes--the Danish diet, Cancer and health cohort study. Nutrients. 2015;7(10):8633–44.CrossRefPubMedPubMedCentral
7.
Li Y, Roswall N, Sandin S, Strom P, Adami HO, Weiderpass E. Adherence to a healthy Nordic food index and breast cancer risk: results from a Swedish cohort study. Cancer Causes Control. 2015;26(6):893–902.CrossRefPubMed
8.
Roswall N, Li Y, Kyro C, Sandin S, Lof M, Adami HO, et al. No association between adherence to a healthy Nordic food index and colorectal Cancer: results from a Swedish cohort study. Cancer Epidemiol Biomark Prev. 2015;24(4):755–7.CrossRef
9.
Roswall N, Sandin S, Lof M, Skeie G, Olsen A, Adami HO, et al. Adherence to the healthy Nordic food index and total and cause-specific mortality among Swedish women. Eur J Epidemiol. 2015;30(6):509–17.CrossRefPubMed
10.
Roswall N, Sandin S, Scragg R, Lof M, Skeie G, Olsen A, et al. No association between adherence to the healthy Nordic food index and cardiovascular disease amongst Swedish women: a cohort study. J Intern Med. 2015;278(5):531–41.CrossRefPubMed
11.
Bach-Faig A, Berry EM, Lairon D, Reguant J, Trichopoulou A, Dernini S, et al. Mediterranean diet pyramid today. Science and cultural updates. Public Health Nutr. 2011;14(12A):2274–84.CrossRefPubMed
12.
Estruch R, Ros E, Salas-Salvado J, Covas MI, Corella D, Aros F, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368(14):1279–90.CrossRefPubMed
13.
Grosso G, Marventano S, Yang J, Micek A, Pajak A, Scalfi L, et al. A comprehensive meta-analysis on evidence of Mediterranean diet and cardiovascular disease: are individual components equal? Crit Rev Food Sci Nutr. 2017;57(15):3218–32.CrossRefPubMed
14.
Tong TY, Wareham NJ, Khaw KT, Imamura F, Forouhi NG. Prospective association of the Mediterranean diet with cardiovascular disease incidence and mortality and its population impact in a non-Mediterranean population: the EPIC-Norfolk study. BMC Med. 2016;14:135.CrossRefPubMedPubMedCentral
15.
Salas-Salvado J, Guasch-Ferre M, Lee CH, Estruch R, Clish CB, Ros E. Protective effects of the Mediterranean diet on type 2 diabetes and metabolic syndrome. J Nutr. 2016;146(4):920S–7S.CrossRefPubMedCentral
16.
Toledo E, Salas-Salvado J, Donat-Vargas C, Buil-Cosiales P, Estruch R, Ros E, et al. Mediterranean diet and invasive breast Cancer risk among women at high cardiovascular risk in the PREDIMED trial: a randomized clinical trial. JAMA Intern Med. 2015;175(11):1752–60.CrossRefPubMed
17.
InterAct C, Romaguera D, Guevara M, Norat T, Langenberg C, Forouhi NG, et al. Mediterranean diet and type 2 diabetes risk in the European prospective investigation into Cancer and nutrition (EPIC) study: the InterAct project. Diabetes Care. 2011;34(9):1913–8.CrossRef
18.
Jannasch F, Kroger J, Schulze MB. Dietary patterns and type 2 diabetes: a systematic literature review and meta-analysis of prospective studies. J Nutr. 2017;147(6):1174–82.CrossRefPubMed
19.
Schwingshackl L, Missbach B, Konig J, Hoffmann G. Adherence to a Mediterranean diet and risk of diabetes: a systematic review and meta-analysis. Public Health Nutr. 2015;18(7):1292–9.CrossRefPubMed
20.
Schwingshackl L, Schwedhelm C, Galbete C, Hoffmann G. Adherence to Mediterranean diet and risk of Cancer: an updated systematic review and meta-analysis. Nutrients. 2017;9(10).
21.
Hoffman R, Gerber M. Evaluating and adapting the Mediterranean diet for non-Mediterranean populations: a critical appraisal. Nutr Rev. 2013;71(9):573–84.CrossRefPubMed
22.
Boeing H, Korfmann A, Bergmann MM. Recruitment procedures of EPIC-Germany. European investigation into Cancer and nutrition. Ann Nutr Metab. 1999;43(4):205–15.CrossRefPubMed
23.
Boeing H, Wahrendorf J, Becker N. EPIC-Germany--A source for studies into diet and risk of chronic diseases. European Investigation into Cancer and Nutrition. Ann Nutr Metab. 1999;43(4):195–204.CrossRefPubMed
24.
Bohlscheid-Thomas S, Hoting I, Boeing H, Wahrendorf J. Reproducibility and Relative validity of food group intake in a food frequency questionnaire developed for the German part of the EPIC project. European prospective investigation into Cancer and nutrition. Int J Epidemiol. 1997;26(Suppl 1):S59–70.CrossRefPubMed
25.
Kroke A, Klipstein-Grobusch K, Voss S, Moseneder J, Thielecke F, Noack R, et al. Validation of a self-administered food-frequency questionnaire administered in the European prospective investigation into Cancer and nutrition (EPIC) study: comparison of energy, protein, and macronutrient intakes estimated with the doubly labeled water, urinary nitrogen, and repeated 24-h dietary recall methods. Am J Clin Nutr. 1999;70(4):439–47.CrossRefPubMed
26.
27.
Bere E, Brug J. Towards health-promoting and environmentally friendly regional diets - a Nordic example. Public Health Nutr. 2009;12(1):91–6.CrossRefPubMed
28.
Kanerva N, Kaartinen NE, Schwab U, Lahti-Koski M, Mannisto S. The Baltic Sea diet score: a tool for assessing healthy eating in Nordic countries. Public Health Nutr. 2014;17(8):1697–705.CrossRefPubMed
29.
Perala MM, von Bonsdorff M, Mannisto S, Salonen MK, Simonen M, Kanerva N, et al. A healthy Nordic diet and physical performance in old age: findings from the longitudinal Helsinki birth cohort study. Br J Nutr. 2016;115(5):878–86.CrossRefPubMed
30.
Trichopoulou A, Costacou T, Bamia C, Trichopoulos D. Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med. 2003;348(26):2599–608.CrossRefPubMed
31.
Buckland G, Agudo A, Lujan L, Jakszyn P, Bueno-de-Mesquita HB, Palli D, et al. Adherence to a Mediterranean diet and risk of gastric adenocarcinoma within the European prospective investigation into Cancer and nutrition (EPIC) cohort study. Am J Clin Nutr. 2010;91(2):381–90.CrossRefPubMed
32.
Bergmann MM, Bussas U, Boeing H. Follow-up procedures in EPIC-Germany--data quality aspects. European prospective investigation into Cancer and nutrition. Ann Nutr Metab. 1999;43(4):225–34.CrossRefPubMed
33.
Roswall N, Eriksson U, Sandin S, Lof M, Olsen A, Skeie G, et al. Adherence to the healthy Nordic food index, dietary composition, and lifestyle among Swedish women. Food Nutr Res. 2015;59:26336.CrossRefPubMed
34.
Kanerva N, Kaartinen NE, Schwab U, Lahti-Koski M, Mannisto S. Adherence to the Baltic Sea diet consumed in the Nordic countries is associated with lower abdominal obesity. Br J Nutr. 2013;109(3):520–8.CrossRefPubMed
35.
Kanerva N, Loo BM, Eriksson JG, Leiviska J, Kaartinen NE, Jula A, et al. Associations of the Baltic Sea diet with obesity-related markers of inflammation. Ann Med. 2014;46(2):90–6.CrossRefPubMed
36.
Mithril C, Dragsted LO, Meyer C, Tetens I, Biltoft-Jensen A, Astrup A. Dietary composition and nutrient content of the new Nordic diet. Public Health Nutr. 2013;16(5):777–85.CrossRefPubMed
37.
Schwingshackl L, Lampousi AM, Portillo MP, Romaguera D, Hoffmann G, Boeing H. Olive oil in the prevention and management of type 2 diabetes mellitus: a systematic review and meta-analysis of cohort studies and intervention trials. Nutr Diabetes. 2017;7(4):e262.CrossRefPubMedPubMedCentral
38.
Schwingshackl L, Hoffmann G, Lampousi AM, Knuppel S, Iqbal K, Schwedhelm C, et al. Food groups and risk of type 2 diabetes mellitus: a systematic review and meta-analysis of prospective studies. Eur J Epidemiol. 2017;32(5):363–75.CrossRefPubMedPubMedCentral
39.
Widmer RJ, Flammer AJ, Lerman LO, Lerman A. The Mediterranean diet, its components, and cardiovascular disease. Am J Med. 2015;128(3):229–38.CrossRefPubMed
40.
Mostofsky E, Chahal HS, Mukamal KJ, Rimm EB, Mittleman MA. Alcohol and immediate risk of cardiovascular events: a systematic review and dose-response meta-analysis. Circulation. 2016;133(10):979–87.CrossRefPubMedPubMedCentral
41.
Bell S, Daskalopoulou M, Rapsomaniki E, George J, Britton A, Bobak M, et al. Association between clinically recorded alcohol consumption and initial presentation of 12 cardiovascular diseases: population based cohort study using linked health records. BMJ. 2017;356:j909.CrossRefPubMedPubMedCentral
42.
Bedard A, Riverin M, Dodin S, Corneau L, Lemieux S. Sex differences in the impact of the Mediterranean diet on cardiovascular risk profile. Br J Nutr. 2012;108(8):1428–34.CrossRefPubMed
43.
Knopp RH, Paramsothy P, Retzlaff BM, Fish B, Walden C, Dowdy A, et al. Gender differences in lipoprotein metabolism and dietary response: basis in hormonal differences and implications for cardiovascular disease. Curr Atheroscler Rep. 2005;7(6):472–9.CrossRefPubMed
44.
Lapointe A, Balk EM, Lichtenstein AH. Gender differences in plasma lipid response to dietary fat. Nutr Rev. 2006;64(5 Pt 1):234–49.CrossRefPubMed
45.
Bach A, Serra-Majem L, Carrasco JL, Roman B, Ngo J, Bertomeu I, et al. The use of indexes evaluating the adherence to the Mediterranean diet in epidemiological studies: a review. Public Health Nutr. 2006;9(1A):132–46.CrossRefPubMed
46.
47.
Mila-Villarroel R, Bach-Faig A, Puig J, Puchal A, Farran A, Serra-Majem L, et al. Comparison and evaluation of the reliability of indexes of adherence to the Mediterranean diet. Public Health Nutr. 2011;14(12A):2338–45.CrossRefPubMed
48.
Wirth J, di Giuseppe R, Boeing H, Weikert C. A Mediterranean-style diet, its components and the risk of heart failure: a prospective population-based study in a non-Mediterranean country. Eur J Clin Nutr. 2016;70(9):1015–21.CrossRefPubMed
49.
Sofi F, Macchi C, Abbate R, Gensini GF, Casini A. Mediterranean diet and health status: an updated meta-analysis and a proposal for a literature-based adherence score. Public Health Nutr. 2014;17(12):2769–82.CrossRefPubMed
50.
Trichopoulou A, Kouris-Blazos A, Wahlqvist ML, Gnardellis C, Lagiou P, Polychronopoulos E, et al. Diet and overall survival in elderly people. BMJ. 1995;311(7018):1457–60.CrossRefPubMedPubMedCentral
51.
Ocke MC. Evaluation of methodologies for assessing the overall diet: dietary quality scores and dietary pattern analysis. Proc Nutr Soc. 2013;72(2):191–9.CrossRefPubMed
52.
Kristal AR, Peters U, Potter JD. Is it time to abandon the food frequency questionnaire? Cancer Epidemiol Biomark Prev. 2005;14(12):2826–8.CrossRef
53.
Willett WC, Hu FB. Not the time to abandon the food frequency questionnaire: point. Cancer Epidemiol Biomark Prev. 2006;15(10):1757–8.CrossRef
Metadata
Title
Nordic diet, Mediterranean diet, and the risk of chronic diseases: the EPIC-Potsdam study
Authors
Cecilia Galbete
Janine Kröger
Franziska Jannasch
Khalid Iqbal
Lukas Schwingshackl
Carolina Schwedhelm
Cornelia Weikert
Heiner Boeing
Matthias B. Schulze
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2018
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/s12916-018-1082-y

Other articles of this Issue 1/2018

BMC Medicine 1/2018 Go to the issue

Opinion

Using flawed, uncertain, proximate and sparse (FUPS) data in the context of complexity: learning from the case of child mental health

Research article

Near-death experiences, attacks by family members, and absence of health care in their home countries affect the quality of life of refugee women in Germany: a multi-region, cross-sectional, gender-sensitive study

Research article

Class-modeling analysis reveals T-cell homeostasis disturbances involved in loss of immune control in elite controllers

Research article

Progress toward eliminating TB and HIV deaths in Brazil, 2001–2015: a spatial assessment

Research article

Modelling the cost-effectiveness of pay-for-performance in primary care in the UK

Research article

Gestational weight gain charts for different body mass index groups for women in Europe, North America, and Oceania