title: Adherence to the healthy Nordic food index, dietary composition, and lifestyle among Swedish women.
abstract: Background : Studies examining diet scores in relation to health outcomes are gaining ground. Thus, control for dietary factors not part of the score, and lifestyle associated with adherence, is required to allow for a causal interpretation of studies on diet scores and health outcomes. Objective : The study objective is to describe and investigate dietary composition, micronutrient density, lifestyle, socioeconomic factors, and adherence to the Nordic Nutrition Recommendations across groups defined by their level of adherence to a healthy Nordic food index (HNFI). The paper examines both dietary components included in the HNFI as well as dietary components, which are not part of the HNFI, to get a broad picture of the diet. Design : The study is cross-sectional and conducted in the Swedish Women's Lifestyle and Health cohort. We included 45,277 women, aged 29-49 years at baseline (1991-1992). The HNFI was defined by six items: wholegrain bread, oatmeal, apples/pears, cabbages, root vegetables and fish/shellfish, using data from a food frequency questionnaire. Proportions, means and standard deviations were calculated in the entire cohort and by adherence groups. Results : Women scoring high on the HNFI had a higher energy intake, compared to low adherers. They had a higher intake of fiber and a higher micronutrient density (components of the HNFI), but also a higher intake of items not included in the HNFI: red/processed meats, sweets, and potatoes. They were on average more physically active and less likely to smoke. Conclusions : Adherence to the HNFI was associated with a generally healthier lifestyle and a high intake of health-beneficial components. However, it was also associated with a higher energy intake and a higher intake of foods without proven health benefits. Therefore, future studies on the HNFI and health outcomes should take into account potential confounding of dietary and lifestyle factors associated with the HNFI.
authors.affiliation: Danish Cancer Society Research Center, Copenhagen, Denmark.|Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; roswall@cancer.dk.
authors.forename: Nina
authors.initials: N
authors.lastname: Roswall
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Eriksson
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Sven
authors.initials: S
authors.lastname: Sandin
authors.affiliation: Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Marie
authors.initials: M
authors.lastname: Löf
authors.affiliation: Danish Cancer Society Research Center, Copenhagen, Denmark.
authors.forename: Anja
authors.initials: A
authors.lastname: Olsen
authors.affiliation: Department of Community Medicine, University of Tromsö, The Arctic University of Norway, Tromsö, Norway.
authors.forename: Guri
authors.initials: G
authors.lastname: Skeie
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.|Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Hans-Olov
authors.initials: HO
authors.lastname: Adami
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.|Department of Community Medicine, University of Tromsö, The Arctic University of Norway, Tromsö, Norway.|Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland.|The Cancer Registry of Norway, Oslo, Norway.
authors.forename: Elisabete
authors.initials: E
authors.lastname: Weiderpass
keywords: Nordic Nutrition Recommendations; adherence; cross-sectional study; dietary pattern; healthy Nordic diet; lifestyle