Gunnar Johansson

Effects of a healthy Nordic diet on cardiovascular risk factors in hypercholesterolaemic subjects : a randomized controlled trial (NORDIET)

Abstract.u2002 Adamsson V, Reumark A, Fredriksson I‐B, Hammarström E, Vessby B, Johansson G, Risérus U (Uppsala University, Uppsala; Lantmännen R&D, Stockholm; Bollnäs Heart Clinic, Mitt Hjärta, Bollnäs; Halmstad University, Halmstad, Sweden). Effects of a healthy Nordic diet on cardiovascular risk factors in hypercholesterolaemic subjects: a randomized controlled trial (NORDIET). J Intern Med 2011; 269: 150–159.

What is a healthy Nordic diet? Foods and nutrients in the NORDIET study

Background A healthy Nordic diet (ND), a diet based on foods originating from the Nordic countries, improves blood lipid profile and insulin sensitivity and lowers blood pressure and body weight in hypercholesterolemic subjects. Objective To describe and compare food and nutrient composition of the ND in relation to the intake of a Swedish reference population (SRP) and the recommended intake (RI) and average requirement (AR), as described by the Nordic nutrition recommendations (NNR). Design The analyses were based on an estimate of actual food and nutrient intake of 44 men and women (mean age 53±8 years, BMI 26±3), representing an intervention arm receiving ND for 6 weeks. Results The main difference between ND and SRP was the higher intake of plant foods, fish, egg and vegetable fat and a lower intake of meat products, dairy products, sweets and desserts and alcoholic beverages during ND (p<0.001 for all food groups). Intake of cereals and seeds was similar between ND and SRP (p>0.3). The relative intake of protein, fat and carbohydrates during ND was in accordance with RI. Intake of all vitamins and minerals was above AR, whereas sodium intake was below RI. Conclusions When compared with the food intake of an SRP, ND is primarily a plant-based diet. ND represents a balanced food intake that meets the current RI and AR of NNR 2004 and has a dietary pattern that is associated with decreased morbidity and mortality.

Diet, disease activity, and gastrointestinal symptoms in patients with ankylosing spondylitis

The aims of this study were to investigate, firstly, the relationship between diet and disease activity and, secondly, the presence of gastrointestinal symptoms and their relationship to diet among patients with ankylosing spondylitis (AS) using a cross-sectional design. One hundred sixty-five individuals diagnosed with AS were invited to complete a self-administered postal questionnaire regarding demographic data, diet, medication, and gastrointestinal symptoms in addition to two established disease assessment questionnaires, i.e., the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI). No significant correlation between diet and disease activity was found. Overall, 27% of the patients reported aggravating gastrointestinal problems when consuming certain foodstuff(s). The 30% of patients who reported suffering from gastrointestinal pain had significantly greater disease activity and poorer functional status according to their BASDAI and BASFI scores (pu2009<u20090.01 and pu2009=u20090.01, respectively). Patients who reported gastrointestinal pain had a significantly higher consumption of vegetables (pu2009<u20090.01) and lower consumption of milk and soured milk (pu2009=u20090.04). No significant correlation was found between the use of non-steroidal anti-inflammatory drugs (NSAID) and gastrointestinal symptoms. In multiple regression models, BASDAI and the consumption of vegetables were independent and statistically significant predictors of gastrointestinal pain. To conclude, in a group of Swedish AS patients, no correlation between diet and disease activity could be detected. There were, however, correlations between diet and gastrointestinal pain. Gastrointestinal problems were also found to be prevalent in AS, independent of NSAID usage.

Modifiable cardiovascular risk factors in patients with ankylosing spondylitis

The aim of this study was to evaluate whether modifiable cardiovascular disease (CVD) risk factors, e.g. atherogenic blood lipids, hypertension and lifestyle-related factors such as smoking, diet and physical inactivity, differ among patients with ankylosing spondylitis (AS) in comparison to the general population. Eighty-eight patients diagnosed with AS were identified by analysis of the databases of a previous community intervention programme, the Västerbotten intervention programme. The patients were compared with 351 controls matched for age, sex and study period. These databases include the results of blood samples analysed for cholesterol, triglycerides and plasma glucose, as well as data on hypertension, height, weight, smoking and dietary habits and physical activity. No significant differences were found between patients and controls regarding hypertension, body mass index, physical activity, diet or smoking. Levels of serum triglycerides (pu2009<u20090.01) and cholesterol (pu2009<u20090.01) were significantly lower in the patient group. Among the patients, the level of triglycerides correlated inversely with the intake of total fat (rsu2009=u2009−0.25, pu2009<u20090.05), monounsaturated fats (rsu2009=u2009−0.29, pu2009<u20090.05) and positively correlated to the intake of carbohydrates (rsu2009=u20090.26, pu2009<u20090.05). These associations were not apparent among the controls. In the cohort of AS patients studied, no differences were found regarding the modifiable risk factors for CVD compared with the general population. Hence, the increased presence of CVD in patients with AS may be caused by other factors such as differences in metabolism and medication such as NSAID or the chronic low-grade inflammation present in the disease.

Dietary Advice on Prescription Experiences with a Weight Reduction Programme

AIMS AND OBJECTIVESnTo describe overweight persons experiences with weight reduction and participation in the dietary advice on prescription.nnnBACKGROUNDnApproximately 20% of overweight individuals are able to successfully lose weight. Experiences from earlier weight reduction programmes indicate that those who succeed typically manage to avoid overeating to handle stress and have high motivation to lose weight. Those who fail have low self-control and engage in negative health behaviours such as eating when experiencing negative emotions and stress.nnnDESIGNnThe study used a descriptive qualitative design and was conducted at a Primary Health Care Centre in south-west Sweden.nnnMETHODSnThe first nineteen study participants who completed the weight reduction programme in two years responded in writing to five open questions about their experiences with the programme. Data were analysed using inductive content analysis.nnnRESULTSnThe participants appreciated the face-to-face meetings with the nurse because they felt seen and listened to during these sessions. They also felt their life situations and self-discipline had an impact on how well they were able to follow the programme. Dietary advice on prescription advice was considered to be helpful for achieving behavioural changes and losing weight. People who succeeded in sustainably losing weight described the importance of support from partners or close friends.nnnCONCLUSIONSnTo achieve sustainable weight reduction, it is important to individualise the programme in order to address each persons life situation and the unique difficulties they may encounter.nnnRELEVANCE TO CLINICAL PRACTICEnMotivational interviewing appears to be a good technique for developing a successful relationship between the nurse and the patient. The dietary advice on prescription advice was perceived to be a good way to improve food habits and can easily be used at many Primary Health Care Centres. Patients partners should also be offered the opportunity to participate in the programme.