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Interventions and public health nutrition

Effects of an isocaloric healthy Nordic diet on ambulatory blood pressure in metabolic syndrome: a randomized SYSDIET sub-study

Abstract

Background/objectives:

Dietary pattern is central in the prevention of hypertension and blood pressure (BP)-related diseases. A diet based on healthy Nordic foods may have a favourable impact on BP. The objective was to clarify whether a Nordic alternative for a healthy food pattern would have beneficial effects on ambulatory BP in subjects with metabolic syndrome (MetS).

Subjects/methods:

In total, 37 subjects were randomized to either a healthy Nordic diet or a control diet. A healthy Nordic diet embraced whole grains, rapeseed oil, berries, fruits, vegetables, fish, nuts and low-fat dairy products of Nordic origin. The mean nutrient intake in the Nordic countries formed the control diet, embracing wheat products, dairy fat-based spread and a lower intake of fruits, vegetables and fish. Diets were isoenergetic. Ambulatory BP was monitored and 24-h urine was collected before and after 12 weeks of intervention.

Results:

After 12 weeks, ambulatory diastolic BP (−4.4 mm Hg; P=0.001) and mean arterial pressure (−4.2 mm Hg; P=0.006) were lowered by the healthy Nordic diet compared with the control diet, whereas changes in ambulatory systolic BP did not differ significantly between diets (−3.5 mm Hg; P=0.122). Heart rate tended to be lower in those on the healthy Nordic diet (P=0.057). Urinary sodium and potassium excretions were unaffected by diets and consequently not associated with the healthy Nordic diet-induced lowering of BP.

Conclusions:

Consumption of Nordic varieties of health-enhancing foods for 12 weeks decreased diastolic ambulatory BP and mean arterial pressure in subjects with features of MetS during weight-stable condition, suggesting beneficial effects of a healthy Nordic dietary pattern on ambulatory BP.

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References

  1. Lawes CM, Vander HS, Rodgers A . Global burden of blood-pressure-related disease, 2001. Lancet 2008; 371: 1513–1518.

    Article  PubMed  Google Scholar 

  2. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289: 2560–2572.

    Article  CAS  PubMed  Google Scholar 

  3. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R . Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360: 1903–1913.

    Article  PubMed  Google Scholar 

  4. Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009; 120: 1640–1645.

    Article  CAS  PubMed  Google Scholar 

  5. Hermansen K . Diet, blood pressure and hypertension. Br J Nutr 2000; 83 (Suppl 1), S113–S119.

    CAS  PubMed  Google Scholar 

  6. Van HL, McCoin M, Kris-Etherton PM, Burke F, Carson JA, Champagne CM et al. The evidence for dietary prevention and treatment of cardiovascular disease. J Am Diet Assoc 2008; 108: 287–331.

    Article  Google Scholar 

  7. Kastorini CM, Milionis HJ, Esposito K, Giugliano D, Goudevenos JA, Panagiotakos DB . The effect of Mediterranean diet on metabolic syndrome and its components: a meta-analysis of 50 studies and 534,906 individuals. J Am Coll Cardiol 2011; 57: 1299–1313.

    Article  CAS  PubMed  Google Scholar 

  8. 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: 455–461.

    Article  CAS  PubMed  Google Scholar 

  9. Bere E, Brug J . Towards health-promoting and environmentally friendly regional diets - a Nordic example. Public Health Nutr 2009; 12: 91–96.

    Article  PubMed  Google Scholar 

  10. 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: 639–644.

    Article  CAS  PubMed  Google Scholar 

  11. Adamsson V, Reumark A, Fredriksson IB, Hammarstrom E, Vessby B, Johansson G et al. 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.

    Article  CAS  PubMed  Google Scholar 

  12. Uusitupa M, Hermansen K, Savolainen MJ, Schwab U, Kolehmainen M, Brader L 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 Intern Med 2013; 274: 52–66.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Baxheinrich A, Stratmann B, Lee-Barkey YH, Tschoepe D, Wahrburg U . Effects of a rapeseed oil-enriched hypoenergetic diet with a high content of alpha-linolenic acid on body weight and cardiovascular risk profile in patients with the metabolic syndrome. Br J Nutr 2012; 108: 682–691.

    Article  CAS  PubMed  Google Scholar 

  14. Pins JJ, Geleva D, Keenan JM, Frazel C, O'Connor PJ, Cherney LM . Do whole-grain oat cereals reduce the need for antihypertensive medications and improve blood pressure control? J Fam Pract 2002; 51: 353–359.

    PubMed  Google Scholar 

  15. Saltzman E, Das SK, Lichtenstein AH, Dallal GE, Corrales A, Schaefer EJ et al. An oat-containing hypocaloric diet reduces systolic blood pressure and improves lipid profile beyond effects of weight loss in men and women. J Nutr 2001; 131: 1465–1470.

    Article  CAS  PubMed  Google Scholar 

  16. Erlund I, Koli R, Alfthan G, Marniemi J, Puukka P, Mustonen P et al. Favorable effects of berry consumption on platelet function, blood pressure, and HDL cholesterol. Am J Clin Nutr 2008; 87: 323–331.

    Article  CAS  PubMed  Google Scholar 

  17. Erkkila AT, Schwab US, de Mello VD, Lappalainen T, Mussalo H, Lehto S . Effects of fatty and lean fish intake on blood pressure in subjects with coronary heart disease using multiple medications. Eur J Nutr 2008; 47: 319–328.

    Article  PubMed  Google Scholar 

  18. Siervo M, Lara J, Ogbonmwan I, Mathers JC . Inorganic nitrate and beetroot juice supplementation reduces blood pressure in adults: a systematic review and meta-analysis. J Nutr 2013; 143: 818–826. e-pub ahead of print 17 April 2013 doi:10.3945/jn.112.170233.

    Article  CAS  PubMed  Google Scholar 

  19. Wang L, Manson JE, Gaziano JM, Buring JE, Sesso HD . Fruit and vegetable intake and the risk of hypertension in middle-aged and older women. Am J Hypertens 2012; 25: 180–189.

    Article  CAS  PubMed  Google Scholar 

  20. Kris-Etherton PM, Grieger JA, Hilpert KF, West SG . Milk products, dietary patterns and blood pressure management. J Am Coll Nutr 2009; 28 (Suppl 1), 103S–119S.

    Article  CAS  PubMed  Google Scholar 

  21. Toledo E, Delgado-Rodriguez M, Estruch R, Salas-Salvado J, Corella D, Gomez-Gracia E et al. Low-fat dairy products and blood pressure: follow-up of 2290 older persons at high cardiovascular risk participating in the PREDIMED study. Br J Nutr 2009; 101: 59–67.

    Article  CAS  PubMed  Google Scholar 

  22. Becker W, Lyhne N, Pedersen A, Aro A, Fogelholm M, Thórsdottir I (eds) Nordic nutrition recommendations 2004. integrating nutrition and physical activity 4th edn. Nordic Council of Ministers: Copenhagen, DK, 2004.

    Book  Google Scholar 

  23. Spitzer RL, Yanovski S, Wadden T, Wing R, Marcus MD, Stunkard A et al. Binge eating disorder: its further validation in a multisite study. Int J Eat Disord 1993; 13: 137–153.

    Article  CAS  PubMed  Google Scholar 

  24. Knudsen VK, Fagt S, Trolle E, Matthiessen J, Groth MV, Biltoft-Jensen A et al. Evaluation of dietary intake in Danish adults by means of an index based on food-based dietary guidelines. Food Nutr Res 2012; 56: 17129 Available at http://dx.doi.org/10.3402/fnr.v56i0.17129.

    Article  CAS  Google Scholar 

  25. Bingham SA, Gill C, Welch A, Cassidy A, Runswick SA, Oakes S et al. Validation of dietary assessment methods in the UK arm of EPIC using weighed records, and 24-hour urinary nitrogen and potassium and serum vitamin C and carotenoids as biomarkers. Int J Epidemiol 1997; 26 (Suppl 1), S137–S151.

    Article  PubMed  Google Scholar 

  26. O'Brien E, Waeber B, Parati G, Staessen J, Myers MG . Blood pressure measuring devices: recommendations of the European Society of Hypertension. BMJ 2001; 322: 531–536.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Verdecchia P, Schillaci G, Guerrieri M, Gatteschi C, Benemio G, Boldrini F et al. Circadian blood pressure changes and left ventricular hypertrophy in essential hypertension. Circulation 1990; 81: 528–536.

    Article  CAS  PubMed  Google Scholar 

  28. Bingham SA . Urine nitrogen as a biomarker for the validation of dietary protein intake. J Nutr 2003; 133 (Suppl 3), 921S–924S.

    Article  CAS  PubMed  Google Scholar 

  29. Leclercq C, Maiani G, Polito A, Ferro-Luzzi A . Use of PABA test to check completeness of 24-h urine collections in elderly subjects. Nutrition 1991; 7: 350–354.

    CAS  PubMed  Google Scholar 

  30. Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med 1997; 336: 1117–1124.

    Article  CAS  PubMed  Google Scholar 

  31. Law MR, Morris JK, Wald NJ . Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ 2009; 338: b1665.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Cook NR, Cohen J, Hebert PR, Taylor JO, Hennekens CH . Implications of small reductions in diastolic blood pressure for primary prevention. Arch Intern Med 1995; 155: 701–709.

    Article  CAS  PubMed  Google Scholar 

  33. Parati G, de Leeuw P, Illyes M, Julius S, Kuwajima I, Mallion JM et al. Blood pressure measurement in research. Blood Press Monit 2002; 7: 83–87.

    Article  PubMed  Google Scholar 

  34. Schwingshackl L, Strasser B, Hoffmann G . Effects of monounsaturated fatty acids on cardiovascular risk factors: a systematic review and meta-analysis. Ann Nutr Metab 2011; 59: 176–186.

    Article  CAS  PubMed  Google Scholar 

  35. Pedersen A, Baumstark MW, Marckmann P, Gylling H, Sandström B . An olive rich-diet results in higher concentrations of LDL cholesterol and a higher number of LDL subfraction particles than rapeseed oil and sunflower oil diets. J Lipid Res 2000; 41: 1901–1911.

    CAS  PubMed  Google Scholar 

  36. Altorf-van der Kuil W, Engberink MF, Brink EJ, van Baak MA, Bakker SJ, Navis G . Dietary protein and blood pressure: a systematic review. PLoS One 2010; 5: e12102.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Mann SJ, Gerber LM . Estimation of 24-hour sodium excretion from spot urine samples. J Clin Hypertens (Greenwich) 2010; 12: 174–180.

    Article  CAS  Google Scholar 

  38. Smith SR, Klotman PE, Svetkey LP . Potassium chloride lowers blood pressure and causes natriuresis in older patients with hypertension. J Am Soc Nephrol 1992; 2: 1302–1309.

    CAS  PubMed  Google Scholar 

  39. Park KM, Cifelli CJ . Dairy and blood pressure: a fresh look at the evidence. Nutr Rev 2013; 71: 149–157.

    Article  PubMed  Google Scholar 

  40. Mutanen M, Kleemola P, Valsta LM, Mensink RP, Rasanen L . Lack of effect on blood pressure by polyunsaturated and monounsaturated fat diets. Eur J Clin Nutr 1992; 46: 1–6.

    CAS  PubMed  Google Scholar 

  41. Hallund J, Madsen BO, Bugel SH, Jacobsen C, Jakobsen J, Krarup H et al. The effect of farmed trout on cardiovascular risk markers in healthy men. Br J Nutr 2010; 104: 1528–1536.

    Article  CAS  PubMed  Google Scholar 

  42. Kuzeytemiz M, Karaagac K, Vatansever F, Ozluk OA, Yilmaz M, Arslan B et al. The Effect of Non-dipper and Dipper Blood Pressure Patterns on Aortic Elasticity in Patients with Metabolic Syndrome. Clin Exp Hypertens 2013, e-pub ahead of print 2013 doi:10.3109/10641963.2013.776572.

  43. Yano Y, Kario K . Nocturnal blood pressure and cardiovascular disease: a review of recent advances. Hypertens Res 2012; 35: 695–701.

    Article  PubMed  Google Scholar 

  44. Bao DQ, Mori TA, Burke V, Puddey IB, Beilin LJ . Effects of dietary fish and weight reduction on ambulatory blood pressure in overweight hypertensives. Hypertension 1998; 32: 710–717.

    Article  CAS  PubMed  Google Scholar 

  45. Rasmussen OW, Thomsen C, Hansen KW, Vesterlund M, Winther E, Hermansen K . Effects on blood pressure, glucose, and lipid levels of a high-monounsaturated fat diet compared with a high-carbohydrate diet in NIDDM subjects. Diabetes Care 1993; 16: 1565–1571.

    Article  CAS  PubMed  Google Scholar 

  46. Staessen JA, Thijs L, Fagard R, O'Brien ET, Clement D, de Leeuw PW . Predicting cardiovascular risk using conventional vs ambulatory blood pressure in older patients with systolic hypertension. Systolic Hypertension in Europe Trial Investigators. JAMA 1999; 282: 539–546.

    CAS  PubMed  Google Scholar 

  47. Poslusna K, Ruprich J, de Vries JH, Jakubikova M, van't Veer P . Misreporting of energy and micronutrient intake estimated by food records and 24 hour recalls, control and adjustment methods in practice. Br J Nutr 2009; 101 (Suppl 2), S73–S85.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The study was funded by NordForsk NCoE in Food Nutrition and Health: Project 070014 SYSDIET (Systems biology in controlled dietary interventions and cohort studies), Aarhus University, Denmark, and the Danish Strategic Research Council (DairyHealth). The following companies provided foods for the study participants: Lantmännen, Wasa, Jan Import A/S, Royal Greenland A/S, Glyngøre Limfjord A/S, Scandic Food A/S, Ardo A/S, Arla Foods and Unilever. The companies had no influence on design, implementation, analysis or interpretation of the data.

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Correspondence to L Brader.

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Brader, L., Uusitupa, M., Dragsted, L. et al. Effects of an isocaloric healthy Nordic diet on ambulatory blood pressure in metabolic syndrome: a randomized SYSDIET sub-study. Eur J Clin Nutr 68, 57–63 (2014). https://doi.org/10.1038/ejcn.2013.192

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