A healthy Nordic food index

A healthy Nordic food index Anja Olsen Danish Cancer Society Research Center Health effects of the Nordic diet November 13 th 2013

Outline Why study Nordic diet? How to construct a healthy Nordic food index Associations to mortality and CRC Why Nordic foods? Perspectives

Why study Nordic diet?

The Nordic Centre of Excellence HELGA Nordic Health - Whole Grain Food Whole grains and human health in the Nordic countries 5-year program funded by NordForsk, 2007-2012 http://www.helgawholegrain.org/

Aims of the HELGA study To study the health effects of whole grain foods focusing on clinical, epidemiological and anthropological aspects Research based on food science; biomarker research; metabolomics; intervention and cohort studies; epidemiology and anthropology

Median intake (g/day) Calculated whole-grain intake 80 75 70 65 60 55 50 45 40 35 Men Women 30 25 20 15 10 5 0 Norway Sweden Denmark USA

Intake of whole-grain types 100% 90% 80% 70% 60% 50% 40% Norway Sweden Denmark 30% 20% 10% 0% Wheat Rye Oat Other

Whole grains and health Beneficial effect with regard to metabolic factors (body weight, insulin resistance etc.) Dietary fibers (lower transit time, wrapping of carcinogens) Vitamins, minerals and antioxidants Phytoestrogens

Whole grains Colorectal cancer Per three servings daily (90 g/day) of whole grains. Aune et al., BMJ 2011; 343:d6617.

Whole grain Type 2 diabetes Ye et al. J Nutr 2012

Whole grain Heart disease Ye et al. J Nutr 2012

Healthy Nordic foods? Whole grain is eaten in higher amounts in the Nordic countries than most other western societies Evidence for beneficial effects of whole grain is accumulating Does the Nordic diet contain other foods with potential health promoting effects????

Is the Nordic diet healthy? Slide 13

A healthy Nordic food index Are some of the foods items traditionally eaten in the Nordic countries associated with positive health outcomes?

A HEALTHY Nordic food index Not to evaluate the Nordic diet as a whole!

How to construct a healthy Nordic food index

1 point for sex-specific median intake Above: MUFA/SFA Moderate alcohol Legumes Grains (originally WG) Fruit Vegetables Moderate dairy Below: Meat/meat products

Criteria for inclusion into the index 1. Originating from the Nordic nature 2. A quantitative role in the daily Nordic diet, both in the (near) past and currently 3. Ascribed beneficial health effects 4. Information obtainable

A healthy Nordic food index Food items considered: Whole grain (rye, oat, wheat) Cabbages Fish and shellfish Apples and pears Berries Root vegetables Rapeseed oils?????

Methods The Diet cancer and Health cohort: 57,053 men and women 50 64 years at baseline (1993-1997) Information about diet and lifestyle from questionnaire

A healthy Nordic food index Food items included: Rye bread Oatmeal Cabbages Fish Apples and pears Root vegetables Berries Shellfish Rapeseed oil

Foods included in the healthy Nordic food index Food item g/day* Fish 41/35 Root vegetables 16/29 Rye bread 63 Oatmeal 21 Apples and pears 56/71 Intake above the gender-specific cut-off (median) = 1 point Index with values from: 0 points (lowest) 6 points (highest) Cabbages 15/16 * Men/Women

Associations to mortality and colorectal cancer

Methods The Diet cancer and Health cohort: 57,053 men and women 50 64 years at baseline (1993-1997) Information about diet and lifestyle from questionnaire Followed for 12 years 4126 deaths 1,025 colorectal cancer

A healthy Nordic food index and all cause mortality Mortality according to level of adherence to the index (per one point increment) No. deaths/cohort MRR (95%CI) 1 MRR (95%CI) 2 Men 2383/23,274 0.86 (0.83-0.88) 0.96 (0.92-0.99) Women 1743/27,016 0.87 (0.84-0.90) 0.96 (0.92-1.00) 1 Adjusted for age and time under study 2 Additionally adjusted for smoking (status, duration, consumption, time since cessation), alcohol, education, sport, BMI, red meat, processed meat and total energy

MRR A healthy Nordic food index and all cause mortality 1,2 Men n 23 274 1 0,8 0,6 0,4 0,2 0 0 (low) 1 2 3 4 5 6 (high) Healthy Nordic food index points

MRR A healthy Nordic food index and all cause mortality 1,2 Women n 27 016 1 0,8 0,6 0,4 0,2 0 0 (low) 1 2 3 4 5 6 (high) Healthy Nordic food index points

A healthy Nordic food index and all cause mortality Food item g/day Men* Women* Fish 41/35 1.07 (0.98-1.17) 1.06 (0.97-1.18) Root vegetables 16/29 0.96 (0.87-1.05) 0.89 (0.80-0.99) Rye bread 63 0.84 (0.75-0.94) 0.90 (0.80-1.01) Oatmeal 21 0.91 (0.82-1.02) 0.97 (0.84-1.11) Apple/pears 56/71 0.97 (0.89-1.06) 1.05 (0.95-1.17) Cabbages 15/16 0.93 (0.84-1.02) 0.89 (0.81-0.99) * Adjusted as previously + mutually adjusted

A healthy Nordic food index and colorectal cancer Colorectal cancer incidence according to level of adherence to the index (one point increment) No. cases/cohort IRR (95%CI) 1 IRR (95%CI) 2 Men 567/26,664 0.95 (0.89-1.01) 1.00 (0.93-1.07) Women 458/29,217 0.91 (0.85-0.98) 0.91(0.84-0.99) 1 Adjusted for age and time under study 2 Additionally adjusted for smoking, alcohol, HRT (women), NSAID, education, sport, waist circumference, red+processed meat, total energy

IRR A healthy Nordic food index and colorectal cancer 1,4 Men n 26 664 1,2 1 0,8 0,6 0,4 0,2 0 0 1 (low) 2 3 4 5 6 (high) Healthy Nordic food index category Analyses adjusted for age and time under study + additionally adjusted for smoking, alcohol, HRT use (women), NSAID, education, sport, waist circumference, red and processed meat intake, energy

IRR A healthy Nordic food index and colorectal cancer 1,4 Women n 29 216 1,2 1 0,8 0,6 0,4 0,2 0 0 1 (low) 2 3 4 5 6 (high) Healthy Nordic food index category Analyses adjusted for age and time under study + additionally adjusted for smoking, alcohol, HRT use (women), NSAID, education, sport, waist circumference, red and processed meat intake, energy

A healthy Nordic food index and colorectal cancer Food item g/day Men* Women* Fish >41/35 0.96 (0.81-1.13) 0.89 (0.73-1.08) Root vegetables >16/19 0.91 (0.75-1.10) 1.01 (0.83-1.24) Rye bread >63 0.87 (0.74-1.03) 0.91 (0.73-1.13) Oatmeal >21 0.94 (0.74-1.18) 0.96 (0.73-1.23) Apples and pears >56/71 1.06 (0.89-1.27) 0.97 (0.80-1.18) Cabbages >15/16 1.11 (0.92-1.34) 0.84 (0.69-1.03) * Adjusted as previously + mutually adjusted

Conclusions Adherence to the index seemed associated to both mortality and colorectal cancer (women) incidence Lowering in risk comparable to previously reported studies of the Mediterranean food index

A 2-point increase in adherence to the Mediterranean diet and all-cause mortality Sofi, F. et al. Am J Clin Nutr 2010;92:1189-1196

A healthy Nordic food index and all cause mortality Mortality according to level of adherence to the index (per one point increment) No. deaths/cohort MRR (95%CI) 1 MRR (95%CI) 2 Men 2383/23,274 0.86 (0.83-0.88) 0.96 (0.92-0.99) Women 1743/27,016 0.87 (0.84-0.90) 0.96 (0.92-1.00) 1 Adjusted for age and time under study 2 Additionally adjusted for smoking (status, duration, consumption, time since cessation), alcohol, education, sport, BMI, red meat, processed meat and total energy

Why Nordic foods?

Why Nordic food? Postulate: It is easier to increase intake of well known foods than to adopt to more unfamiliar dietary habits! Especially for those reluctant to dietary changes!

Pespectives

Perspectives Further development to fit other Nordic populations Associations to other endpoints Biomarkers related to a healthy Nordic diet

Nordic foods for the world? Some of the foods relevant in worldwide perspective? Food culture? Challenge the Mediterranean diet?

Conclusion A high intake of healthy Nordic food items seem associated to improved health The public health potential is considerable!...but it may primarily be relevant to us!!!!

THANK YOU FOR YOUR ATTENTION! anja@cancer.dk