Nordic diet in metabolic syndrome, sysdiet

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  • 1. Effects of an isocaloric healthyNordic diet on insulin sensitivity,lipid profile and inflammationmarkers in metabolic syndrome – arandomized study (SYSDIET)Uusitupa M et al. J Intern Med 2013; doi: 10.1111/joim.12044.
  • 2. Nordic Diet is a diet rich in berries,root vegetables, fish, rye/other wholegrains and canola oil2
  • 3. Background• There is ample evidence on benefits of Mediterranean diet oncardiovascular, cognitive and cancer outcomes (Sofi et al. 2010,AJCN). The cardiovascular benefits have not only beendemonstrated in prospective cohort studies but also in threelarge randomized hard endpoint trials (PREDIMED, Lyon DietHeart and Oslo Diet Heart)• It’s not known if Nordic Diet, a diet pattern based on berries,cabbages, root vegetables, apple, pear, canola oil, margarine,low fat dairy will lead to similar reductions in cardiovascular riskfactors• Nordic diet pattern has been associated with improved survivalin a cross-sectional cohort (Olsen et al. 2011), but it’s effects inmetabolic syndrome are unknownPage 3
  • 4. MethodsPage 4
  • 5. Page 5Randomization of participantswith metabolic syndromen = 200 Nordic dietAt the end; N=96 (7,9 % drop out)Control diet; high in refined wheat and butterAt the end; N=70 (27 % drop out)Follow up: 18 or 24 weeksHabitual (usual) dietRun-in 4 weeksSee next 2 slides for details regarding dietary instructions
  • 6. Page 6Nordic diet ↑Control diet ↓~ 8 small slices of white wheat bread * or similaramount white pasta, buns etc~ butter or butter-oil spread asonly visible fat* My estimation at the level of 2000 kcal/day, see next slideFish minmum 3 timesa weekCanola oil ormargarine asonly visiblefat≤ 1 fish portions per weekMinimum 500grams ofberries, fruitand veggies adayMaximum 250grams ofberries, fruitand veggies adayMinimum 6 small slices*of high-fiber-bread, brownrice or whole grain pastadaily
  • 7. Underlined food items weredelivered to participants for free
  • 8. Goals of study diets regardingnutritional values (Supplement online)Page 8
  • 9. ResultsPage 9
  • 10. Baseline values, no significantdifferences existedPage 10
  • 11. Biggest changes observed in SFA,PUFA, Fiber, Vit C and beta-caroteneintakesPage 11
  • 12. Changes in food consumption andnutrient intake• There is no data available on how well participantscomplied with the instructions regarding specific fooditems in respective group• However, the reported intakes of nutrients suggest thatparticipants made major changes in both groups– Intake of fibre, vitamin C and β-carotene was two times higherduring Nordic dietPage 12
  • 13. Changes in risk factors (1/2)- Non-HDL cholesterol- LDL/HDL –ratio- IL-1Ra (increase waspositively associated with SFA& negatively with Mg)- Apo B/Apo A1 –ratio– LDL cholesterol– HDL cholesterol– Blood pressure– f-glucose– insulin sensitivity, ie.Matsuda index– CRP– TNF-α– IL-1β– IL-6– IL-10– Apo B– Apo A1Page 13Significant differencesbetween the groupsNO difference betweenthe groups
  • 14. Changes in risk factors (2/2)Page 14
  • 15. DiscussionPage 15
  • 16. My speculations• Nordic diet induced improvement in some lipid parameters and oneinflammatory marker (IL-1Ra) when compared to the control diet• The value of the findings is a matter of debate– Unhealthy control diet was not habitual diet of the participants– Control diet may have been worse than usual diet among theparticipants. Oils, margarine, oily fish and whole grains arefrequently consumed in Nordic populations– There was no difference in LDL, nor in HDL cholesterol– There was no difference in CRP, IL-6 or in any other inflammatorymarker beyond IL-1Ra– There were no changes in insulin sensitivity, glucose homeostasisor blood pressure• Drop out rate was higher in the control group possibly indicatingpoor acceptance of unhealthy control diet• The cultural differences in Nordic countries may have impactedadherence to certain food itemsPage 16
  • 17. AftermathPage 17
  • 18. This is how it went.And this is how it goes with many diet studies
  • 19. 4 Opinion,comment,blog3 News2 Pressrelease1 Scientificpaper (article)All parties add their own spice untilconclusions become distortedAuthorspresentresultsUniversitysells the storyto mediaMedia sellsthe story topeopleSomeonefurtherexaggeratesand modifiesdata/context
  • 20. Still remember?The control diet was not habitual, norconventional diet …Page 20
  • 21. Page 21University of Eastern Finland (pressrelease)
  • 22. Page 22University of Eastern Finland, pressrelease
  • 23. Still remember?LDL and HDL were not differentbetween the diets.Their combined value LDL/HDL –ratio was different. Also non-HDLcholesterol was different.Page 24
  • 24. Page 25Lund university, press release
  • 25. Media: Cholesterol may not benews enough.“Let’s make it better than Mediterranean diet”Page 26
  • 26. Finnish media
  • 27. Finnish media
  • 28. Still remember?1. The Mediterranean diet was notpart of this study2. Mediterranean diet is effectivein reducing inflammation,cholesterol, heart attacks, strokesand cancer according to meta-analyses of prospective cohortsand randomized trials
  • 29. One rather critical view on thestudy
  • 30. National Health Services (NHS),UK**Analysis written by Bazian, a company giving ”evidencebased support for health care commissioning”
  • 31. National Health Services (NHS),UK*
  • 32. I’m fan a of Nordic Diet and enjoyregularly berries, fish, rootvegetables, rye bread and other”Scandinavian” food items.Page 35
  • 33. I just think that the study resultsshould be presented as accuratelyas possible without rhetoric
  • 34. Other publications on Nordic diet1) Adamsson V et al. Effects of a healthy Nordic diet on cardiovascularrisk factors in hypercholesterolaemic subjects: a randomizedcontrolled trial (NORDIET). J Intern Med. 2011 Feb;269(2):150-9.2) Kyrø C et al. Adherence to a healthy Nordic food index is associatedwith a lower incidence of colorectal cancer in women: the Diet, Cancerand Health cohort study. Br J Nutr. 2013 Mar 14;109(5):920-73) Mithril C et al. Guidelines for the New Nordic Diet. Public Health Nutr.2012 Oct;15(10):1941-74) Olsen A et al. Healthy aspects of the Nordic diet are related to lowertotal mortality. J Nutr. 2011 Apr 1;141(4):639-44
  • 35. Want to find more recent distortedclaims?Try search words:“Basu, Lustig sugar is toxic”“Willet aspartame leukemia”“Taubes low carbohydrate NuSi”Page 38
  • 36. Welcome aboard!25/06/201339http://twitter.com/pronutritionisthttp://www.facebook.com/pronutritionisthttp://www.pronutritionist.net (Finnish)http://www.pronutritionistblog.com (English)Reijo Laatikainen, Authorized Nutritionist, MBAPhotos: Bigstockphoto and Kotimaiset kasvikset