title: Adherence to the healthy Nordic food index and total and cause-specific mortality among Swedish women.
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.
authors.affiliation: Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen Ø, Denmark, Roswall@cancer.dk.
authors.forename: Nina
authors.initials: N
authors.lastname: Roswall
authors.forename: Sven
authors.initials: S
authors.lastname: Sandin
authors.forename: Marie
authors.initials: M
authors.lastname: Löf
authors.forename: Guri
authors.initials: G
authors.lastname: Skeie
authors.forename: Anja
authors.initials: A
authors.lastname: Olsen
authors.forename: Hans-Olov
authors.initials: HO
authors.lastname: Adami
authors.forename: Elisabete
authors.initials: E
authors.lastname: Weiderpass
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D004032:Diet; D002523:Edible Grain; D005247:Feeding Behavior; D005260:Female; D005638:Fruit; D006293:Health Promotion; D006801:Humans; D008875:Middle Aged; D009026:Mortality; D009369:Neoplasms / Q000401:mortality; D009664:Norway; D011446:Prospective Studies; D012044:Regression Analysis; D013548:Sweden / Q000453:epidemiology; D014675:Vegetables