AIMS/HYPOTHESIS: Nordic dietary patterns that are high in healthy traditional Nordic foods may have a role in the prevention and management of diabetes. To inform the update of the EASD clinical practice guidelines for nutrition therapy, we conducted a systematic review and meta-analysis of Nordic dietary patterns and cardiometabolic outcomes. METHODS: We searched MEDLINE, EMBASE and The Cochrane Library from inception to 9 March 2021. We included prospective cohort studies and RCTs with a follow-up of ≥1 year and ≥3 weeks, respectively. Two independent reviewers extracted relevant data and assessed the risk of bias (Newcastle-Ottawa Scale and Cochrane risk of bias tool). The primary outcome was total CVD incidence in the prospective cohort studies and LDL-cholesterol in the RCTs. Secondary outcomes in the prospective cohort studies were CVD mortality, CHD incidence and mortality, stroke incidence and mortality, and type 2 diabetes incidence; in the RCTs, secondary outcomes were other established lipid targets (non-HDL-cholesterol, apolipoprotein B, HDL-cholesterol, triglycerides), markers of glycaemic control (HbA1c, fasting glucose, fasting insulin), adiposity (body weight, BMI, waist circumference) and inflammation (C-reactive protein), and blood pressure (systolic and diastolic blood pressure). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of the evidence. RESULTS: We included 15 unique prospective cohort studies (n=1,057,176, with 41,708 cardiovascular events and 13,121 diabetes cases) of people with diabetes for the assessment of cardiovascular outcomes or people without diabetes for the assessment of diabetes incidence, and six RCTs (n=717) in people with one or more risk factor for diabetes. In the prospective cohort studies, higher adherence to Nordic dietary patterns was associated with 'small important' reductions in the primary outcome, total CVD incidence (RR for highest vs lowest adherence: 0.93 [95% CI 0.88, 0.99], p=0.01; substantial heterogeneity: I2=88%, pQ<0.001), and similar or greater reductions in the secondary outcomes of CVD mortality and incidence of CHD, stroke and type 2 diabetes (p<0.05). Inverse dose-response gradients were seen for total CVD incidence, CVD mortality and incidence of CHD, stroke and type 2 diabetes (p<0.05). No studies assessed CHD or stroke mortality. In the RCTs, there were small important reductions in LDL-cholesterol (mean difference [MD] -0.26 mmol/l [95% CI -0.52, -0.00], pMD=0.05; substantial heterogeneity: I2=89%, pQ<0.01), and 'small important' or greater reductions in the secondary outcomes of non-HDL-cholesterol, apolipoprotein B, insulin, body weight, BMI and systolic blood pressure (p<0.05). For the other outcomes there were 'trivial' reductions or no effect. The certainty of the evidence was low for total CVD incidence and LDL-cholesterol; moderate to high for CVD mortality, established lipid targets, adiposity markers, glycaemic control, blood pressure and inflammation; and low for all other outcomes, with evidence being downgraded mainly because of imprecision and inconsistency. CONCLUSIONS/INTERPRETATION: Adherence to Nordic dietary patterns is associated with generally small important reductions in the risk of major CVD outcomes and diabetes, which are supported by similar reductions in LDL-cholesterol and other intermediate cardiometabolic risk factors. The available evidence provides a generally good indication of the likely benefits of Nordic dietary patterns in people with or at risk for diabetes. REGISTRATION: ClinicalTrials.gov NCT04094194. FUNDING: Diabetes and Nutrition Study Group of the EASD Clinical Practice.

Centro de Investigacion Biomedica en Red de Fisiopatología de la Obesidad y Nutrición Instituto de Salud Carlos 3 Madrid Spain

Clinical Nutrition and Risk Factor Modification Centre St Michael's Hospital Toronto ON Canada

College of Pharmacy and Nutrition University of Saskatchewan Saskatoon SK Canada

Croatian Catholic University School of Medicine Zagreb Croatia

Department of Clinical Medicine Aarhus University Aarhus Denmark

Department of Endocrinology and Internal Medicine Aarhus University Hospital Aarhus Denmark

Department of Medicine Endocrinology and Clinical Nutrition Kuopio University Hospital Kuopio Finland

Department of Medicine Temerty Faculty of Medicine University of Toronto Toronto ON Canada

Department of Nutrition Harvard T H Chan School of Public Health Boston MA USA

Department of Nutritional Sciences Temerty Faculty of Medicine University of Toronto Toronto ON Canada

Department of Public Health and Caring Sciences Clinical Nutrition and Metabolism Uppsala University Uppsala Sweden

Division of Endocrinology and Metabolism Department of Medicine St Michael's Hospital Toronto ON Canada

Division of Medicine Department of Clinical Service Section of Nutrition and Dietetics Oslo University Hospital Oslo Norway

Human Nutrition Department IISPV Universitat Rovira i Virgili Reus Spain

Institute for Clinical and Experimental Medicine Diabetes Centre Prague Czech Republic

Institute of Public Health and Clinical Nutrition Faculty of Health Sciences University of Eastern Finland Kuopio Finland

Joannah and Brian Lawson Centre for Child Nutrition Temerty Faculty of Medicine University of Toronto Toronto ON Canada

Josip Juraj Strossmayer University School of Medicine Osijek Croatia

Landspitali University Hospital of Iceland Reykjavík Iceland

Li Ka Shing Knowledge Institute St Michael's Hospital Toronto ON Canada

Physicians Committee for Responsible Medicine Washington DC USA

Toronto 3D Knowledge Synthesis and Clinical Trials Unit Toronto ON Canada

Unit for Nutrition Research Health Science Institute University of Iceland Reykjavík Iceland

Vuk Vrhovac University Clinic for Diabetes Endocrinology and Metabolic Diseases Merkur University Hospital Zagreb Croatia

Women's College Research Institute Women's College Hospital Toronto ON Canada

Zobrazit více v PubMed

Pinto X, Fanlo-Maresma M, Corbella E, et al. A Mediterranean Diet Rich in Extra-Virgin Olive Oil Is Associated with a Reduced Prevalence of Nonalcoholic Fatty Liver Disease in Older Individuals at High Cardiovascular Risk. J Nutr. 2019;149(11):1920–1929. doi: 10.1093/jn/nxz147. PubMed DOI

Babio N, Toledo E, Estruch R, et al. Mediterranean diets and metabolic syndrome status in the PREDIMED randomized trial. CMAJ. 2014;186(17):E649–E657. doi: 10.1503/cmaj.140764. PubMed DOI PMC

Becerra-Tomas N, Blanco Mejia S, Viguiliouk E, et al. Mediterranean diet, cardiovascular disease and mortality in diabetes: A systematic review and meta-analysis of prospective cohort studies and randomized clinical trials. Crit Rev Food Sci Nutr. 2020;60(7):1207–1227. doi: 10.1080/10408398.2019.1565281. PubMed DOI

Elhayany A, Lustman A, Abel R, Attal-Singer J, Vinker S. A low carbohydrate Mediterranean diet improves cardiovascular risk factors and diabetes control among overweight patients with type 2 diabetes mellitus: a 1-year prospective randomized intervention study. Diabetes Obes Metab. 2010;12(3):204–209. doi: 10.1111/j.1463-1326.2009.01151.x. PubMed DOI

Esposito K, Maiorino MI, Ciotola M, et al. Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes: a randomized trial. Ann Int Med. 2009;151(5):306–314. doi: 10.7326/0003-4819-151-5-200909010-00004. PubMed DOI

Huo R, Du T, Xu Y, et al. Effects of Mediterranean-style diet on glycemic control, weight loss and cardiovascular risk factors among type 2 diabetes individuals: a meta-analysis. Eur J Clin Nutr. 2015;69(11):1200–1208. doi: 10.1038/ejcn.2014.243. PubMed DOI

Salas-Salvado J, Bullo M, Babio N, et al. Reduction in the incidence of type 2 diabetes with the Mediterranean diet: results of the PREDIMED-Reus nutrition intervention randomized trial. Diabetes Care. 2011;34(1):14–19. doi: 10.2337/dc10-1288. PubMed DOI PMC

Salas-Salvado J, Bullo M, Babio N, et al. Erratum. Reduction in the Incidence of Type 2 Diabetes With the Mediterranean Diet: Results of the PREDIMED-Reus nutrition intervention randomized trial. Diabetes Care 2011;34:14-19. Diabetes Care. 2018;41(10):2259–2260. doi: 10.2337/dc18-er10. PubMed DOI PMC

Shai I, Schwarzfuchs D, Henkin Y, et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008;359(3):229–241. doi: 10.1056/NEJMoa0708681. PubMed DOI

Chiavaroli L, Viguiliouk E, Nishi SK, et al. DASH Dietary Pattern and Cardiometabolic Outcomes: An Umbrella Review of Systematic Reviews and Meta-Analyses. Nutrients. 2019;11(2):338. doi: 10.3390/nu11020338. PubMed DOI PMC

Chiavaroli L, Nishi SK, Khan TA, et al. Portfolio Dietary Pattern and Cardiovascular Disease: A Systematic Review and Meta-analysis of Controlled Trials. Prog Cardiovasc Dis. 2018;61(1):43–53. doi: 10.1016/j.pcad.2018.05.004. PubMed DOI

Glenn AJ, Hernandez-Alonso P, Kendall CWC, et al. Longitudinal changes in adherence to the portfolio and DASH dietary patterns and cardiometabolic risk factors in the PREDIMED-Plus study. Clin Nutr. 2021;40(5):2825–2836. doi: 10.1016/j.clnu.2021.03.016. PubMed DOI

Glenn AJ, Lo K, Jenkins DJA, et al. Relationship Between a Plant-Based Dietary Portfolio and Risk of Cardiovascular Disease: Findings From the Women's Health Initiative Prospective Cohort Study. J Am Heart Assoc. 2021;10(16):e021515. doi: 10.1161/JAHA.121.021515. PubMed DOI PMC

Jenkins DJ, Chiavaroli L, Wong JM, et al. Adding monounsaturated fatty acids to a dietary portfolio of cholesterol-lowering foods in hypercholesterolemia. CMAJ. 2010;182(18):1961–1967. doi: 10.1503/cmaj.092128. PubMed DOI PMC

Jenkins DJ, Jones PJ, Lamarche B et al (2011) Effect of a dietary portfolio of cholesterol-lowering foods given at 2 levels of intensity of dietary advice on serum lipids in hyperlipidemia: a randomized controlled trial. JAMA 306(8):831–839. 10.1001/jama.2011.1202 PubMed

Jenkins DJ, Kendall CW, Faulkner D, et al. A dietary portfolio approach to cholesterol reduction: combined effects of plant sterols, vegetable proteins, and viscous fibers in hypercholesterolemia. Metabolism. 2002;51(12):1596–1604. doi: 10.1053/meta.2002.35578. PubMed DOI

Jenkins DJ, Kendall CW, Faulkner DA, et al. Assessment of the longer-term effects of a dietary portfolio of cholesterol-lowering foods in hypercholesterolemia. Am J Clin Nutr. 2006;83(3):582–591. doi: 10.1093/ajcn.83.3.582. PubMed DOI

Jenkins DJ, Kendall CW, Marchie A, et al. The effect of combining plant sterols, soy protein, viscous fibers, and almonds in treating hypercholesterolemia. Metabolism. 2003;52(11):1478–1483. doi: 10.1016/s0026-0495(03)00260-9. PubMed DOI

Jenkins DJ, Kendall CW, Marchie A et al (2003) Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein. JAMA 290(4):502–510. 10.1001/jama.290.4.502 PubMed

Glenn AJ, Viguiliouk E, Seider M, et al. Relation of Vegetarian Dietary Patterns With Major Cardiovascular Outcomes: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. Front Nutr. 2019;6:80. doi: 10.3389/fnut.2019.00080. PubMed DOI PMC

Viguiliouk E, Kendall CW, Kahleova H, et al. Effect of vegetarian dietary patterns on cardiometabolic risk factors in diabetes: A systematic review and meta-analysis of randomized controlled trials. Clin Nutr. 2019;38(3):1133–1145. doi: 10.1016/j.clnu.2018.05.032. PubMed DOI

Tong TYN, Imamura F, Monsivais P, et al. Dietary cost associated with adherence to the Mediterranean diet, and its variation by socio-economic factors in the UK Fenland Study. Br J Nutr. 2018;119:685–694. doi: 10.1017/S0007114517003993. PubMed DOI PMC

Moore SE, Mcevoy CT, Prior L et al (2018) Barriers to adopting a Mediterranean diet in Northern European adults at high risk of developing cardiovascular disease. J Hum Nutr Diet 31:451–462. 10.1111/jhn.12523 PubMed

Papadaki A, Scott JA. The impact on eating habits of temporary translocation from a Mediterranean to a Northern European environment. Eur J Clin Nutr. 2002;56:455–467. doi: 10.1038/sj.ejcn.1601337. PubMed DOI

Slimani N, Fahey M, Welch AA, et al. Diversity of dietary patterns observed in the European Prospective Investigation into Cancer and Nutrition (EPIC) project. Public Health Nutr. 2002;5(6B):1311–1328. doi: 10.1079/PHN2002407. PubMed DOI

Mithril C, Dragsted LO, Meyer C, Blauert E, Holt MK, Astrup A. Guidelines for the New Nordic Diet. Public Health Nutr. 2012;15(10):1941–1947. doi: 10.1017/S136898001100351X. PubMed DOI

Adamsson V, Reumark A, Cederholm T, Vessby B, Risérus U, Johansson G (2012) What is a healthy Nordic diet? Foods and nutrients in the NORDIET study. Food Nutr Res 56. 10.3402/fnr.v56i0.18189 PubMed PMC

Adamsson V, Reumark A, Fredriksson IB, et al. Effects of a healthy Nordic diet on cardiovascular risk factors in hypercholesterolaemic subjects: A randomized controlled trial (NORDIET) J Int Med. 2011;269:150–159. doi: 10.1111/j.1365-2796.2010.02290.x. PubMed DOI

Kanerva N, Kaartinen NE, Schwab U, Lahti-Koski M, Mannisto S. The Baltic Sea Diet Score: a tool for assessing healthy eating in Nordic countries. Public Health Nutr. 2014;17(8):1697–1705. doi: 10.1017/S1368980013002395. PubMed DOI PMC

Becker W, Lyhne N, Pedersen AN, et al. Nordic Nutrition Recommendations 2004-integrating nutrition and physical activity. Scand J Nutr. 2004;48(4):178–187. doi: 10.1080/1102680410003794. DOI

Brader L, Uusitupa M, Dragsted L, Hermansen K. Effects of an isocaloric healthy Nordic diet on ambulatory blood pressure in metabolic syndrome: a randomized SYSDIET sub-study. Eur J Clin Nutr. 2013;68:57–63. doi: 10.1038/ejcn.2013.192. PubMed DOI

Wharton S, Lau DCW, Vallis M, et al. Obesity in adults: a clinical practice guideline. CMAJ. 2020;192(31):E875–E891. doi: 10.1503/cmaj.191707. PubMed DOI PMC

Diabetes Canada Clinical Practice Guidelines Expert Committee, Sievenpiper JL, Chan CB, Dworatzek PD, Freeze C, Williams SL (2018) Nutrition Therapy. Can J Diabetes 42(Suppl 1):S64–S79. 10.1016/j.jcjd.2017.10.009 PubMed

Dyson PA, Twenefour D, Breen C, et al. Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes. Diabet Med. 2018;35(5):541–547. doi: 10.1111/dme.13603. PubMed DOI

Helsedirektoratet (2016) 1. Diagnostikk av diabetes, risikovurdering ognoppfølging av personer med høy risiko for å utvikle diabetes. [1. Diagnosis of diabetes, risk assessment and follow-up of people at high risk of developing diabetes]. In: Diabetes – nasjonal faglig retningslinje [Diabetes – national professional guideline]. Helsedirektoratet, Oslo.

Laakso M, Groop L, Isomaa B, et al. Update on Current Care Guideline. Diabetes. Duodecim. 2016;132(9):881–882. PubMed

Ndanuko RN, Tapsell LC, Charlton KE, Neale EP, Batterham MJ. Dietary Patterns and Blood Pressure in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Adv Nutr (Bethesda, Md) 2016;7:76–89. doi: 10.3945/an.115.009753. PubMed DOI PMC

Zimorovat A, Mohammadi M, Ramezani-Jolfaie N, Salehi-Abargouei A. The healthy Nordic diet for blood glucose control: a systematic review and meta-analysis of randomized controlled clinical trials. Acta Diabetol. 2020;57(1):1–12. doi: 10.1007/s00592-019-01369-8. PubMed DOI

Ramezani-Jolfaie N, Mohammadi M, Salehi-Abargouei A (2019) Effects of a healthy Nordic diet on weight loss in adults: a systematic review and meta-analysis of randomized controlled clinical trials. Eat Weight Disord 25:1141–1150. 10.1007/s40519-019-00773-x PubMed

Sakhaei R, Ramezani-Jolfaie N, Mohammadi M, Salehi-Abargouei A. The healthy Nordic dietary pattern has no effect on inflammatory markers: A systematic review and meta-analysis of randomized controlled clinical trials. Nutrition. 2019;58:140–148. doi: 10.1016/j.nut.2018.06.020. PubMed DOI

Cumpston M, Li T, Page MJ, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev. 2019;10:ED000142. doi: 10.1002/14651858.ED000142. PubMed DOI PMC

Stroup DF, Berlin JA, Morton SC et al (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 283(15):2008–2012. 10.1001/jama.283.15.2008 PubMed

Moher D, Liberati A, Tetzlaff J, Altman DG, Prisma Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Int Med 151(4):264–269, W264. 10.7326/0003-4819-151-4-200908180-00135 PubMed PMC

Higgins JPT, Thomas J, Chandler J, et al., editors. Cochrane handbook for systematic reviews of interventions. 2. Chichester, UK: Wiley; 2019. PubMed PMC

Ritz C, Astrup A, Larsen TM, Hjorth MF. Weight loss at your fingertips: personalized nutrition with fasting glucose and insulin using a novel statistical approach. Eur J Clin Nutr. 2019;73(11):1529–1535. doi: 10.1038/s41430-019-0423-z. PubMed DOI

Wells GA, Shea B, O’Connell D et al (2014) The Newcastle–Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses. Available from http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed 28 Oct 2019

Higgins JP, Altman DG, Gotzsche PC et al (2011) The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 343:d5928. 10.1136/bmj.d5928 PubMed PMC

Zhang J, Yu KF (1998) What's the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA 280(19):1690–1691. 10.1001/jama.280.19.1690 PubMed

Elbourne DR, Altman DG, Higgins JP, Curtin F, Worthington HV, Vail A. Meta-analyses involving cross-over trials: methodological issues. Int J Epidemiol. 2002;31(1):140–149. doi: 10.1093/ije/31.1.140. PubMed DOI

Tufanaru C, Munn Z, Stephenson M, Aromataris E. Fixed or random effects meta-analysis? Common methodological issues in systematic reviews of effectiveness. Int J Evid-Based Healthcare. 2015;13(3):196–207. doi: 10.1097/XEB.0000000000000065. PubMed DOI

Orsini N, Bellocco R, Greenland S. Generalized Least Squares for Trend Estimation of Summarized Dose–response Data. Stata J. 2006;6(1):40–57. doi: 10.1177/1536867x0600600103. DOI

Orsini N, Li R, Wolk A, Khudyakov P, Spiegelman D. Meta-analysis for linear and nonlinear dose-response relations: examples, an evaluation of approximations, and software. Am J Epidemiol. 2012;175(1):66–73. doi: 10.1093/aje/kwr265. PubMed DOI PMC

Crippa A, Discacciati A, Bottai M, Spiegelman D, Orsini N. One-stage dose-response meta-analysis for aggregated data. Stat Methods Med Res. 2019;28(5):1579–1596. doi: 10.1177/0962280218773122. PubMed DOI

Roswall N, Eriksson U, Sandin S, et al. Adherence to the healthy Nordic food index, dietary composition, and lifestyle among Swedish women. Food Nutr Res. 2015;59:26336. doi: 10.3402/fnr.v59.26336. PubMed DOI PMC

Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50(4):1088–1101. doi: 10.2307/2533446. PubMed DOI

Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634. 10.1136/bmj.315.7109.629 PubMed PMC

Duval S, Tweedie R. Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000;56(2):455–463. doi: 10.1111/j.0006-341x.2000.00455.x. PubMed DOI

Brunetti M, Shemilt I, Pregno S, et al. GRADE guidelines: 10. Considering resource use and rating the quality of economic evidence. J Clin Epidemiol. 2013;66:140–150. doi: 10.1016/j.jclinepi.2012.04.012. PubMed DOI

Guyatt GH, Oxman AD, Kunz R, et al. GRADE guidelines 6. Rating the quality of evidence - Imprecision. J Clin Epidemiol. 2011;64:1283–1293. doi: 10.1016/j.jclinepi.2011.01.012. PubMed DOI

Guyatt GH, Oxman AD, Kunz R, et al. GRADE guidelines: 8. Rating the quality of evidence - Indirectness. J Clin Epidemiol. 2011;64:1303–1310. doi: 10.1016/j.jclinepi.2011.04.014. PubMed DOI

Guyatt GH, Oxman AD, Kunz R, et al. GRADE guidelines: 7. Rating the quality of evidence - Inconsistency. J Clin Epidemiol. 2011;64:1294–1302. doi: 10.1016/j.jclinepi.2011.03.017. PubMed DOI

Guyatt GH, Oxman AD, Montori V, et al. GRADE guidelines: 5. Rating the quality of evidence - Publication bias. J Clin Epidemiol. 2011;64:1277–1282. doi: 10.1016/j.jclinepi.2011.01.011. PubMed DOI

Guyatt GH, Oxman AD, Santesso N, et al. GRADE guidelines: 12. Preparing Summary of Findings tables - Binary outcomes. J Clin Epidemiol. 2013;66:158–172. doi: 10.1016/j.jclinepi.2012.01.012. PubMed DOI

Guyatt GH, Oxman AD, Sultan S, et al. GRADE guidelines: 9. Rating up the quality of evidence. J Clin Epidemiol. 2011;64:1311–1316. doi: 10.1016/j.jclinepi.2011.06.004. PubMed DOI

Guyatt GH, Oxman AD, Vist G, et al. GRADE guidelines: 4. Rating the quality of evidence - Study limitations (risk of bias) J Clin Epidemiol. 2011;64:407–415. doi: 10.1016/j.jclinepi.2010.07.017. PubMed DOI

Guyatt GH, Thorlund K, Oxman AD, et al. GRADE guidelines: 13. Preparing Summary of Findings tables and evidence profiles - Continuous outcomes. J Clin Epidemiol. 2013;66:173–183. doi: 10.1016/j.jclinepi.2012.08.001. PubMed DOI

Kaminski-Hartenthaler A, Gartlehner G, Kien C et al (2013) GRADE-Leitlinien: 11. Gesamtbeurteilung des Vertrauens in Effektschätzer für einen einzelnen Studienendpunkt und für alle Endpunkte [article in German]. Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen 107:638–645. 10.1016/j.zefq.2013.10.033 PubMed

Langendam M, Carrasco-Labra A, Santesso N, et al. Improving GRADE evidence tables part 2: a systematic survey of explanatory notes shows more guidance is needed. J Clin Epidemiol. 2016;74:19–27. doi: 10.1016/j.jclinepi.2015.12.008. PubMed DOI

Santesso N, Carrasco-Labra A, Langendam M, et al. Improving GRADE evidence tables part 3: Detailed guidance for explanatory footnotes supports creating and understanding GRADE certainty in the evidence judgments. J Clin Epidemiol. 2016;74:28–39. doi: 10.1016/j.jclinepi.2015.12.006. PubMed DOI

Santesso N, Glenton C, Dahm P, et al. GRADE guidelines 26: informative statements to communicate the findings of systematic reviews of interventions. J Clin Epidemiol. 2020;119:126–135. doi: 10.1016/j.jclinepi.2019.10.014. PubMed DOI

Balshem H, Helfand M, Schunemann HJ, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011;64(4):401–406. doi: 10.1016/j.jclinepi.2010.07.015. PubMed DOI

Schünemann HJ, Higgins JPT, Vist GE et al (2019) Chapter 14: Completing ‘Summary of findings’ tables and grading the certainty of the evidence. In: Higgins JPT, Thomas J, Chandler J, et al (eds) Cochrane handbook for systematic reviews of interventions, 2nd edn. Wiley, Chichester, UK

Schünemann HBJ, Guyatt G, Oxman A (2013) GRADE Handbook. Available from https://gdt.gradepro.org/app/handbook/handbook.html. Accessed 20 June 2022

Fu R, Gartlehner G, Grant M, et al. Conducting quantitative synthesis when comparing medical interventions: AHRQ and the Effective Health Care Program. J Clin Epidemiol. 2011;64(11):1187–1197. doi: 10.1016/j.jclinepi.2010.08.010. PubMed DOI

Schwingshackl L, Knüppel S, Schwedhelm C, et al. Perspective: NutriGrade: a scoring system to assess and judge the meta-evidence of randomized controlled trials and cohort studies in nutrition research. Adv Nutr. 2016;7(6):994–1004. doi: 10.3945/an.116.013052. PubMed DOI PMC

Gunge VB, Andersen I, Kyrø C, et al. Adherence to a healthy Nordic food index and risk of myocardial infarction in middle-aged Danes: The diet, cancer and health cohort study. Eur J Clin Nutr. 2017;71:652–658. doi: 10.1038/ejcn.2017.1. PubMed DOI

Hansen CP, Overvad K, Kyrø C, et al. Adherence to a Healthy Nordic Diet and Risk of Stroke: A Danish Cohort Study. Stroke. 2017;48:259–264. doi: 10.1161/STROKEAHA.116.015019. PubMed DOI

Hlebowicz J, Drake I, Gullberg B, et al. A High Diet Quality Is Associated with Lower Incidence of Cardiovascular Events in the Malmö Diet and Cancer Cohort. PLoS One. 2013;8:e71095. doi: 10.1371/journal.pone.0071095. PubMed DOI PMC

Roswall N, Sandin S, Löf M, et al. Adherence to the healthy Nordic food index and total and cause-specific mortality among Swedish women. Eur J Epidemiol. 2015;30:509–517. doi: 10.1007/s10654-015-0021-x. PubMed DOI

Roswall N, Sandin S, Scragg R, et al. No association between adherence to the healthy Nordic food index and cardiovascular disease amongst Swedish women: A cohort study. J Int Med. 2015;278:531–541. doi: 10.1111/joim.12378. PubMed DOI

Warensjo Lemming E, Byberg L, Wolk A, Michaelsson K. A comparison between two healthy diet scores, the modified Mediterranean diet score and the Healthy Nordic Food Index, in relation to all-cause and cause-specific mortality. Br J Nutr. 2018;119(7):836–846. doi: 10.1017/S0007114518000387. PubMed DOI

Galbete C, Kroger J, Jannasch F, et al. Nordic diet, Mediterranean diet, and the risk of chronic diseases: the EPIC-Potsdam study. BMC Med. 2018;16(1):99. doi: 10.1186/s12916-018-1082-y. PubMed DOI PMC

Puaschitz NG, Assmus J, Strand E et al (2019) Adherence to the Healthy Nordic Food Index and the incidence of acute myocardial infarction and mortality among patients with stable angina pectoris. J Hum Nutr Diet 32(1):86–97. 10.1111/jhn.12592 PubMed

Drake I, Gullberg B, Sonestedt E, et al. Scoring models of a diet quality index and the predictive capability of mortality in a population-based cohort of Swedish men and women. Public Health Nutr. 2013;16:468–478. doi: 10.1017/S1368980012002789. PubMed DOI PMC

Lassale C, Gunter MJ, Romaguera D, et al. Diet quality scores and prediction of all-cause, cardiovascular and cancer mortality in a pan-european cohort study. PLoS One. 2016;11:e0159025. doi: 10.1371/journal.pone.0159025. PubMed DOI PMC

Ewers B, Marott JL, Schnohr P, Nordestgaard BG, Marckmann P (2020) Non-adherence to established dietary guidelines associated with increased mortality: the Copenhagen General Population Study. Eur J Prev Cardiol: 2047487320937491. 10.1177/2047487320937491 PubMed

Kanerva N, Rissanen H, Knekt P, Havulinna AS, Eriksson JG, Mannisto S. The healthy Nordic diet and incidence of Type 2 Diabetes--10-year follow-up. Diabetes Res Clin Pract. 2014;106(2):e34–e37. doi: 10.1016/j.diabres.2014.08.016. PubMed DOI

Lacoppidan SA, Kyrø C, Loft S, et al. Adherence to a Healthy Nordic Food Index Is Associated with a Lower Risk of Type-2 Diabetes--The Danish Diet, Cancer and Health Cohort Study. Nutrients. 2015;7:8633–8644. doi: 10.3390/nu7105418. PubMed DOI PMC

Mandalazi E, Drake I, Wirfalt E, Orho-Melander M, Sonestedt E. A High Diet Quality Based on Dietary Recommendations Is Not Associated with Lower Incidence of Type 2 Diabetes in the Malmo Diet and Cancer Cohort. Int J Mol Sci. 2016;17(6):901. doi: 10.3390/ijms17060901. PubMed DOI PMC

Tertsunen HM, Hantunen S, Tuomainen TP, Virtanen JK. Healthy Nordic diet and risk of disease death among men: the Kuopio Ischaemic Heart Disease Risk Factor Study. Eur J Nutr. 2020;59(8):3545–3553. doi: 10.1007/s00394-020-02188-2. PubMed DOI PMC

Due A, Larsen TM, Mu H, Hermansen K, Stender S, Astrup A. Comparison of 3 ad libitum diets for weight-loss maintenance, risk of cardiovascular disease, and diabetes: a 6-mo randomized, controlled trial. Am J Clin Nutr. 2008;88(5):1232–1241. doi: 10.3945/ajcn.2007.25695. PubMed DOI

Gotfredsen JL, Hoppe C, Andersen R et al (2020) Effects of substitution dietary guidelines targeted at prevention of IHD on dietary intake and risk factors in middle-aged Danish adults: the Diet and Prevention of Ischemic Heart Disease: a Translational Approach (DIPI) randomised controlled trial. Br J Nutr: 1–15. 10.1017/S0007114520005164 PubMed

Huseinovic E, Bertz F, Leu Agelii M, Hellebo Johansson E, Winkvist A, Brekke HK. Effectiveness of a weight loss intervention in postpartum women: results from a randomized controlled trial in primary health care. Am J Clin Nutr. 2016;104(2):362–370. doi: 10.3945/ajcn.116.135673. PubMed DOI

Poulsen SK, Due A, Jordy AB, et al. Health effect of the new nordic diet in adults with increased waist circumference: A 6-mo randomized controlled trial. Am J Clin Nutr. 2014;99:35–45. doi: 10.3945/ajcn.113.069393. PubMed DOI

Uusitupa M, Hermansen K, Savolainen MJ, et al. Effects of an isocaloric healthy Nordic diet on insulin sensitivity, lipid profile and inflammation markers in metabolic syndrome - a randomized study (SYSDIET) J Int Med. 2013;274:52–66. doi: 10.1111/joim.12044. PubMed DOI PMC

Zurbau A, Au-Yeung F, Blanco Mejia S, et al. Relation of Different Fruit and Vegetable Sources With Incident Cardiovascular Outcomes: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. J Am Heart Assoc. 2020;9(19):e017728. doi: 10.1161/JAHA.120.017728. PubMed DOI PMC

De Munter JSL, Hu FB, Spiegelman D, Franz M, van Dam RM. Whole grain, bran, and germ intake and risk of type 2 diabetes: a prospective cohort study and systematic review. PLoS Med. 2007;4(8):e261. doi: 10.1371/journal.pmed.0040261. PubMed DOI PMC

Tang G, Wang D, Long J, Yang F, Si L. Meta-analysis of the association between whole grain intake and coronary heart disease risk. Am J Cardiol. 2015;115(5):625–629. doi: 10.1016/j.amjcard.2014.12.015. PubMed DOI

Reynolds AN. Associations of fats and carbohydrates with cardiovascular disease and mortality-PURE and simple? Lancet. 2018;391(10131):1676. doi: 10.1016/S0140-6736(18)30845-6. PubMed DOI

Bazzano LA, He J, Ogden LG, et al. Legume consumption and risk of coronary heart disease in US men and women: NHANES I Epidemiologic Follow-up Study. Arch Intern Med. 2001;161(21):2573–2578. doi: 10.1001/archinte.161.21.2573. PubMed DOI

Gibbs J, Gaskin E, Ji C, Miller MA, Cappuccio FP. The effect of plant-based dietary patterns on blood pressure: a systematic review and meta-analysis of controlled intervention trials. J Hypertens. 2021;39(1):23–37. doi: 10.1097/HJH.0000000000002604. PubMed DOI

Sukhato K, Akksilp K, Dellow A, Vathesatogkit P, Anothaisintawee T. Efficacy of different dietary patterns on lowering of blood pressure level: an umbrella review. Am J Clin Nutr. 2020;112(6):1584–1598. doi: 10.1093/ajcn/nqaa252. PubMed DOI

Viguiliouk E, Kendall CW, Blanco Mejia S, et al. Effect of tree nuts on glycemic control in diabetes: a systematic review and meta-analysis of randomized controlled dietary trials. PLoS One. 2014;9(7):e103376. doi: 10.1371/journal.pone.0103376. PubMed DOI PMC

Sofi F, Cesari F, Abbate R, Gensini GF, Casini A (2008) Adherence to Mediterranean diet and health status: meta-analysis. BMJ (Clinical research ed) 337. 10.1136/bmj.a1344 PubMed PMC

Appel LJ, Moore TJ, Obarzanek E et al (1997) A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med 117–124. 10.1016/s0022-1910(97)00049-8 PubMed

Olsen A, Egeberg R, Halkjaer J, Christensen J, Overvad K, Tjonneland A. Healthy aspects of the Nordic diet are related to lower total mortality. J Nutr. 2011;141(4):639–644. doi: 10.3945/jn.110.131375. PubMed DOI

Kahleova H, Salas-Salvado J, Rahelic D, Kendall CW, Rembert E, Sievenpiper JL. Dietary Patterns and Cardiometabolic Outcomes in Diabetes: A Summary of Systematic Reviews and Meta-Analyses. Nutrients. 2019;11(9):2209. doi: 10.3390/nu11092209. PubMed DOI PMC

Ho HVT, Jovanovski E, Zurbau A, et al. A systematic review and meta-analysis of randomized controlled trials of the effect of konjac glucomannan, a viscous soluble fiber, on LDL cholesterol and the new lipid targets non-HDL cholesterol and apolipoprotein B. Am J Clin Nutr. 2017;105(5):1239–1247. doi: 10.3945/ajcn.116.142158. PubMed DOI

Ho HV, Sievenpiper JL, Zurbau A et al (2016) Erratum: A systematic review and meta-analysis of randomized controlled trials of the effect of barley beta-glucan on LDL-C, non-HDL-C and apoB for cardiovascular disease risk reduction(i-iv). Eur J Clin Nutr 70(11):1340. 10.1038/ejcn.2016.129 PubMed

Hou Q, Li Y, Li L, et al. The Metabolic Effects of Oats Intake in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis. Nutrients. 2015;7(12):10369–10387. doi: 10.3390/nu7125536. PubMed DOI PMC

Jovanovski E, Khayyat R, Zurbau A, et al. Should Viscous Fiber Supplements Be Considered in Diabetes Control? Results From a Systematic Review and Meta-analysis of Randomized Controlled Trials. Diabetes Care. 2019;42(5):755–766. doi: 10.2337/dc18-1126. PubMed DOI

Heneghan C, Kiely M, Lyons J, Lucey A (2018) The effect of berry-based food interventions on markers of cardiovascular and metabolic health: a systematic review of randomized controlled trials. Mol Nutr Food Res 62(1). 10.1002/mnfr.201700645 PubMed

Choo VL, Viguiliouk E, Blanco Mejia S et al (2018) Food sources of fructose-containing sugars and glycaemic control: systematic review and meta-analysis of controlled intervention studies. BMJ 363:k4644. 10.1136/bmj.k4644 PubMed PMC

Blanco Mejia S, Kendall CW, Viguiliouk E, et al. Effect of tree nuts on metabolic syndrome criteria: a systematic review and meta-analysis of randomised controlled trials. BMJ Open. 2014;4(7):e004660. doi: 10.1136/bmjopen-2013-004660. PubMed DOI PMC

Nishi SK, Viguiliouk E, Blanco Mejia S, et al. Are fatty nuts a weighty concern? A systematic review and meta-analysis and dose-response meta-regression of prospective cohorts and randomized controlled trials. Obes Rev. 2021;22(11):e13330. doi: 10.1111/obr.13330. PubMed DOI PMC

Sabate J, Oda K, Ros E. Nut consumption and blood lipid levels: a pooled analysis of 25 intervention trials. Arch Intern Med. 2010;170(9):821–827. doi: 10.1001/archinternmed.2010.79. PubMed DOI

Li SS, Blanco Mejia S, Lytvyn L, et al. Effect of Plant Protein on Blood Lipids: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Am Heart Assoc. 2017;6(12):e006659. doi: 10.1161/JAHA.117.006659. PubMed DOI PMC

Blanco Mejia S, Messina M, Li SS, et al. A Meta-Analysis of 46 Studies Identified by the FDA Demonstrates that Soy Protein Decreases Circulating LDL and Total Cholesterol Concentrations in Adults. J Nutr. 2019;149(6):968–981. doi: 10.1093/jn/nxz020. PubMed DOI PMC

Ha V, Sievenpiper JL, de Souza RJ, et al. Effect of dietary pulse intake on established therapeutic lipid targets for cardiovascular risk reduction: a systematic review and meta-analysis of randomized controlled trials. CMAJ. 2014;186(8):E252–E262. doi: 10.1503/cmaj.131727. PubMed DOI PMC

Jayalath VH, de Souza RJ, Sievenpiper JL, et al. Effect of dietary pulses on blood pressure: a systematic review and meta-analysis of controlled feeding trials. Am J Hypertens. 2014;27(1):56–64. doi: 10.1093/ajh/hpt155. PubMed DOI PMC

Jenkins DJA, Blanco Mejia S, Chiavaroli L, et al. Cumulative Meta-Analysis of the Soy Effect Over Time. J Am Heart Assoc. 2019;8(13):e012458. doi: 10.1161/JAHA.119.012458. PubMed DOI PMC

Kim SJ, de Souza RJ, Choo VL, et al. Effects of dietary pulse consumption on body weight: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr. 2016;103(5):1213–1223. doi: 10.3945/ajcn.115.124677. PubMed DOI

Sievenpiper JL, Kendall CW, Esfahani A, et al. Effect of non-oil-seed pulses on glycaemic control: a systematic review and meta-analysis of randomised controlled experimental trials in people with and without diabetes. Diabetologia. 2009;52(8):1479–1495. doi: 10.1007/s00125-009-1395-7. PubMed DOI

Viguiliouk E, Blanco Mejia S, Kendall CW, Sievenpiper JL. Can pulses play a role in improving cardiometabolic health? Evidence from systematic reviews and meta-analyses. Ann N Y Acad Sci. 2017;1392(1):43–57. doi: 10.1111/nyas.13312. PubMed DOI PMC

Viguiliouk E, Stewart SE, Jayalath VH, et al. Effect of Replacing Animal Protein with Plant Protein on Glycemic Control in Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients. 2015;7(12):9804–9824. doi: 10.3390/nu7125509. PubMed DOI PMC

Viguiliouk E, Kendall CW, Blanco Mejia S, et al. Effect of tree nuts on glycemic control in diabetes: a systematic review and meta-analysis of randomized controlled dietary trials. PLoS One. 2014;9(7):e103376. doi: 10.1371/journal.pone.0103376. PubMed DOI PMC

Anderson TJ, Gregoire J, Pearson GJ, et al. 2016 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in the Adult. Can J Cardiol. 2016;32(11):1263–1282. doi: 10.1016/j.cjca.2016.07.510. PubMed DOI

Diabetes Canada Clinical Practice Guidelines Expert Committee, Lipscombe L, Butalia S et al (2020) Pharmacologic Glycemic Management of Type 2 Diabetes in Adults: 2020 Update. Can J Diabetes 44(7):575–591. 10.1016/j.jcjd.2020.08.001 PubMed

Sievenpiper JL, Chan CB, Dworatzek PD, Freeze C, Williams SL. Nutrition therapy. Can J Diabetes. 2018;42:S64–S79. doi: 10.1016/j.jcjd.2017.10.009. PubMed DOI

Krznarić Ž, Karas I, Kelečić DL, Bender DV (2021) The Mediterranean and Nordic diet: a review of differences and similarities of two sustainable, health-promoting dietary patterns. Front Nutr 8. 10.3389/fnut.2021.683678 PubMed PMC

Hemler EC, Hu FB. Plant-Based Diets for Cardiovascular Disease Prevention: All Plant Foods Are Not Created Equal. Curr Atheroscler Rep. 2019;21(5):18. doi: 10.1007/s11883-019-0779-5. PubMed DOI

Mudryj AN, Aukema HM, Yu N. Intake patterns and dietary associations of soya protein consumption in adults and children in the Canadian Community Health Survey, Cycle 2.2. Br J Nutr. 2015;113(2):299–309. doi: 10.1017/S0007114514003638. PubMed DOI

Klingberg S, Andersson H, Mulligan A, et al. Food sources of plant sterols in the EPIC Norfolk population. Eur J Clin Nutr. 2008;62(6):695–703. doi: 10.1038/sj.ejcn.1602765. PubMed DOI

Klingberg S, Ellegård L, Johansson I, et al. Inverse relation between dietary intake of naturally occurring plant sterols and serum cholesterol in northern Sweden. Am J Clin Nutr. 2008;87(4):993–1001. doi: 10.1093/ajcn/87.4.993. PubMed DOI

Jenkins DJ, Kendall CW, Popovich DG, et al. Effect of a very-high-fiber vegetable, fruit, and nut diet on serum lipids and colonic function. Metab Clin Exp. 2001;50(4):494–503. doi: 10.1053/meta.2001.21037. PubMed DOI

Bere E, Brug J. Towards health-promoting and environmentally friendly regional diets–a Nordic example. Public Health Nutr. 2009;12(1):91–96. doi: 10.1017/S1368980008001985. PubMed DOI

World Health Organization (2021) Making diets environmentally friendly: Nordic countries lead the way. Available from https://www.euro.who.int/en/health-topics/disease-prevention/nutrition/news/news/2021/10/making-diets-environmentally-friendly-nordic-countries-lead-the-way. Accessed 20 June 2022

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