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. 2018 Sep 12:62.
doi: 10.29219/fnr.v62.1339. eCollection 2018.

Adherence to the Healthy Nordic Food Index in the Norwegian Women and Cancer (NOWAC) cohort

Torill M Enget Jensen  1 , Tonje Braaten  1 , Bjarne Koster Jacobsen  1 , Runa Borgund Barnung  1 , Anja Olsen  2 , Guri Skeie  1
Affiliations

Adherence to the Healthy Nordic Food Index in the Norwegian Women and Cancer (NOWAC) cohort

Torill M Enget Jensen et al. Food Nutr Res. .

Erratum in

  • Corrigendum.
    Jensen TME, Braaten T, Jacobsen BK, Barnung RB, Olsen A, Skeie G. Jensen TME, et al. Food Nutr Res. 2024 May 8;68. doi: 10.29219/fnr.v68.10708. eCollection 2024. Food Nutr Res. 2024. PMID: 38863740 Free PMC article.

Abstract

Background: High adherence to the Healthy Nordic Food Index has been associated with better health outcomes, but the results have not been consistent. The association between high adherence and higher intake of energy and healthy and less healthy foods has been persistent across countries, highlighting the need to examine potential confounding by energy intake.

Objective: This study aimed to examine energy-adjusted dietary factors and lifestyle factors related to the index in a Norwegian context.

Design: The study was cross-sectional within the Norwegian Women and Cancer cohort and included 81,516 women aged 41-76. Information about habitual food intake was based on a food frequency questionnaire (FFQ). The index incorporated six food groups (fish, root vegetables, cabbages, apples/pears, whole grain bread, and breakfast cereals). Ordered trend and regression analyses were performed to assess the association between the index and lifestyle and dietary factors with energy-adjusted models.

Results: Nearly one out of four women (22.8%) had low adherence, 49.0% had medium adherence, and 28.2% had high adherence to the index. Intake of energy and of both healthy and less healthy foods increased with increased adherence. Energy adjustment removed the associations between less healthy foods and high adherence and demonstrated a better dietary composition in high adherers. The healthy Nordic foods contributed more to the total food intake in high versus low adherers, and high adherence was associated with a healthier lifestyle.

Conclusion: High adherence was associated with a healthier lifestyle, both concerning diet and other factors. Energy adjustment of potential confounding foods removed associations between high adherence and less healthy foods. The Nordic foods accounted for a larger fraction of the diet among high adherers, at the expense of other healthy foods. Careful adjustment for confounders is warranted when assessing associations between the index and health outcomes.

Keywords: dietary index; dietary pattern regional diet; energy adjustment; healthy Nordic diet; the environmental impact of foods.

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Conflict of interest statement

The authors have not received any funding or benefits from industry or elsewhere to conduct this study.

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