Enget Jensen Torill M, Braaten Tonje, Jacobsen Bjarne Koster, Barnung Runa Borgund, Olsen Anja, Skeie Guri
Department of Community Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway.
Danish Cancer Society Research Center, Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen 2100, Denmark.
Food Nutr Res. 2018 Sep 12;62. doi: 10.29219/fnr.v62.1339. eCollection 2018.
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.
This study aimed to examine energy-adjusted dietary factors and lifestyle factors related to the index in a Norwegian context.
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.
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.
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.
对健康北欧食物指数的高依从性与更好的健康结果相关，但结果并不一致。在各个国家，高依从性与更高的能量摄入以及健康和不健康食物的摄入量之间的关联一直存在，这凸显了研究能量摄入可能造成的混杂影响的必要性。
本研究旨在探讨挪威背景下与该指数相关的能量调整后的饮食因素和生活方式因素。
该研究是挪威女性与癌症队列中的横断面研究，纳入了81516名年龄在41至76岁之间的女性。关于习惯性食物摄入量的信息基于食物频率问卷（FFQ）。该指数纳入了六个食物组（鱼类、根茎类蔬菜、卷心菜、苹果/梨、全麦面包和早餐谷物）。进行有序趋势分析和回归分析，以评估该指数与生活方式及饮食因素在能量调整模型中的关联。
近四分之一的女性（22.8%）对该指数的依从性低，49.0%的女性依从性中等，28.2%的女性依从性高。随着依从性的增加，能量以及健康和不健康食物的摄入量均增加。能量调整消除了不健康食物与高依从性之间的关联，并表明高依从者的饮食结构更好。与低依从者相比，健康的北欧食物在高依从者的总食物摄入量中占比更大，且高依从性与更健康的生活方式相关。
高依从性与更健康的生活方式相关，在饮食和其他因素方面均如此。对潜在混杂食物进行能量调整消除了高依从性与不健康食物之间的关联。北欧食物在高依从者的饮食中占比更大，而其他健康食物的占比则相应减少。在评估该指数与健康结果之间的关联时，有必要仔细调整混杂因素。
