Effects of a healthy Nordic diet on weight loss in adults: a systematic review and meta-analysis of randomized controlled clinical trials
Studies on the effect of the Nordic diet (ND) on body weight and adiposity indices were conflicting. This study targeted to perform a systematic review and meta-analysis of randomized controlled clinical trials (RCTs) examined the effect of the ND on body weight and composition.
PubMed, Scopus, ISI web of Science, ProQuest and Google Scholar were searched for the eligible studies up to August 2019. The weighted mean difference (WMD) in body weight and composition indices between the ND and control groups/periods was derived using random-effects model.
In total, seven studies (n = 774 participants) were included in the present study. Five studies had illustrated the effect of the ND on weight, three on waist circumference (WC), two on body fat, and two on body mass index (BMI). The pooled analysis of eligible trials showed that those adhered to the ND lost 1.83 kg [95% confidence interval (CI) − 2.94, − 0.73, P = 0.001] more weight compared to controls. Qualitative assessment of other anthropometric indices also showed a beneficial effect of this dietary pattern in improving body fat and BMI values; however, these findings are not conclusive because of limited number of studies.
Adherence to the ND significantly improves body weight; however, there is also no certainty that this diet is effective for improving other anthropometric indices. Future studies regarding the effect of the ND on weight and body composition in populations other than Nordic populations are highly recommended.
Level of evidence Level I, systematic reviews and meta-analyses.
KeywordsNordic diet Baltic Sea diet Body weight Body fat percent Waist circumference Systematic review
Randomized controlled clinical trials
Weighted mean difference
Body mass index
World health organization
Dietary approaches to stop hypertension
Preferred reporting items for systematic reviews and meta-analyses
Prospective register of systematic reviews
Polyunsaturated fatty acids
The authors’ contributions were as follows: ASA, MM and NRJ conceived and designed the research; MM and NRJ conducted systematic research and study selection; MM and NRJ extracted data; ASA and MM analyzed data; NRJ, MM and ASA wrote the manuscript; and all authors read and approved the final manuscript.
The study was funded by the Nutrition and Food Security research center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Compliance with ethical standards
Conflict of interest
There is no conflict of interest to report for this study.
The study protocol was registered and ethically approved by the research council of Shahid Sadoughi University of Medical Sciences (registration code: IR.SSU.SPH.REC.1397.059).
The informed consent was not applicable for the current study.
- 1.World Health Organization (2016) Fact sheet: obesity and overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Accessed 11 Aug 2019
- 5.Shay CM, Van Horn L, Stamler J, Dyer AR, Brown IJ, Chan Q, Miura K, Zhao L, Okuda N, Daviglus ML, Elliott P, Group I.R (2012) Food and nutrient intakes and their associations with lower BMI in middle-aged US adults: the International Study of Macro-/Micronutrients and Blood Pressure (INTERMAP). Am J Clin Nutr 96:483–491CrossRefGoogle Scholar
- 15.Uusitupa M, Hermansen K, Savolainen MJ, Schwab U, Kolehmainen M, Brader L, Mortensen LS, Cloetens L, Johansson-Persson A, Oumlnning G, Landin-Olsson M, Herzig KH, Hukkanen J, Rosqvist F, Iggman D, Paananen J, Pulkki KJ, Siloaho M, Dragsted L, Barri T, Overvad K, Knudsen KEB, Hedemann MS, Arner P, Dahlman I, Borge GIA, Baardseth P, Ulven SM, Gunnarsdottir I, Jonsdottir S, Thorsdottir I, Oresic M, Poutanen KS, Riserus U, Aringkesson B (2013) 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 274:52–66CrossRefGoogle Scholar
- 19.Fritzen AM, Lundsgaard AM, Jordy AB, Poulsen SK, Stender S, Pilegaard H, Astrup A, Larsen TM, Wojtaszewski JF, Richter EA, Kiens B (2015) New Nordic diet-induced weight loss is accompanied by changes in metabolism and ampk signaling in adipose tissue. J Clin Endocrinol Metab 100:3509–3519CrossRefGoogle Scholar
- 20.De Mello VDF, Schwab U, Kolehmainen M, Koenig W, Siloaho M, Poutanen K, Mykkänen H, Uusitupa M (2011) A diet high in fatty fish, bilberries and wholegrain products improves markers of endothelial function and inflammation in individuals with impaired glucose metabolism in a randomised controlled trial: the sysdimet study. Diabetologia 54:2755–2767CrossRefGoogle Scholar
- 21.Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700CrossRefGoogle Scholar
- 22.Mohammadi M, Salehi-Abargouei A, Ramezani Jolfaie N (2017) Effects of Nordic diet on weight and body composition: a systematic review and meta-analysis on controlled clinical trials. PROSPERO [internet]. CRD42017054860. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=54860. Accessed 11 Aug 2019
- 23.Higgins JPT, Green S (2011) Cochrane handbook for systematic reviews of interventions, version 5.1.0. The Cochrane Collaboration. http://handbook-5-1.cochrane.org/. Accessed 11 Aug 2019
- 24.Fritzen AM, Lundsgaard AM, Jordy AB, Poulsen SK, Stender S, Pilegaard H, Astrup A, Larsen TM, Wojtaszewski JFP, Richter EA, Kiens B (2015) New nordic diet-induced weight loss is accompanied by changes in metabolism and AMPK signaling in adipose tissue. J Clin Endocrinol Metab 100:3509–3519CrossRefGoogle Scholar
- 25.Poulsen S, Frost S, Rasmussen L, Astrup A, Larsen T (2011) Weight loss after 12 weeks with new Nordic diet vs. Average Danish diet provided ad libitum—a randomized controlled trial using the shop model. Ann Nutr Metab 58:289Google Scholar
- 26.Kolehmainen M, Ulven SM, Paananen J, De Mello V, Schwab U, Carlberg C, Myhrstad M, Pihlajamäki J, Dungner E, Sjöolin E, Gunnarsdottir I, Cloetens L, Landin-Olsson M, Akesson B, Rosqvist F, Hukkanen J, Herzig KH, Dragsted LO, Savolainen MJ, Brader L, Hermansen K, Risérus U, Thorsdottir I, Poutanen KS, Uusitupa M, Arner P, Dahlman I (2015) Healthy Nordic diet downregulates the expression of genes involved in inflammation in subcutaneous adipose tissue in individuals with features of the metabolic syndrome. Am J Clin Nutr 101:228–239CrossRefGoogle Scholar
- 27.Lankinen M, Kolehmainen M, Jaaskelainen T, Paananen J, Joukamo L, Kangas AJ, Soininen P, Poutanen K, Mykkanen H, Gylling H, Oresic M, Jauhiainen M, Ala-Korpela M, Uusitupa M, Schwab U (2014) Effects of whole grain, fish and bilberries on serum metabolic profile and lipid transfer protein activities: a randomized trial (Sysdimet). Plos One. https://doi.org/10.1371/journal.pone.0090352 Google Scholar
- 31.Egger M, Smith GD, Altman D (2008) Systematic reviews in health care: meta-analysis in context. Wiley, HobokenGoogle Scholar
- 39.Marklund M, Magnusdottir OK, Rosqvist F, Cloetens L, Landberg R, Kolehmainen M, Brader L, Hermansen K, Poutanen KS, Herzig KH, Hukkanen J, Savolainen MJ, Dragsted LO, Schwab U, Paananen J, Uusitupa M, Åkesson B, Thorsdottir I, Risérus U (2014) A dietary biomarker approach captures compliance and cardiometabolic effects of a healthy nordic diet in individuals with metabolic syndrome. J Nutr 144:1642–1649CrossRefGoogle Scholar
- 40.Myhrstad MCW, de Mello VD, Dahlman I, Kolehmainen M, Paananen J, Rundblad A, Carlberg C, Olstad OK, Pihlajamaki J, Holven KB, Hermansen K, Dragsted LO, Gunnarsdottir I, Cloetens L, Storm MU, Akesson B, Rosqvist F, Hukkanen J, Herzig KH, Riserus U, Thorsdottir I, Poutanen KS, Savolainen MJ, Schwab U, Arner P, Uusitupa M, Ulven SM (2019) Healthy Nordic diet modulates the expression of genes related to mitochondrial function and immune response in peripheral blood mononuclear cells from subjects with metabolic syndrome—a SYSDIET sub-study. Mol Nutr Food Res. https://doi.org/10.1002/mnfr.201801405 Google Scholar
- 43.Darwiche G, Höglund P, Roth B, Larsson E, Sjöberg T, Wohlfart B, Steen S, Ohlsson B (2016) An Okinawan-based Nordic diet improves anthropometry, metabolic control, and health-related quality of life in Scandinavian patients with type 2 diabetes: a pilot trial. Food Nutr Res. https://doi.org/10.3402/fnr.v60.32594 Google Scholar
- 50.Weigle DS, Breen PA, Matthys CC, Callahan HS, Meeuws KE, Burden VR, Purnell JQ (2005) A high-protein diet induces sustained reductions in appetite, ad libitum caloric intake, and body weight despite compensatory changes in diurnal plasma leptin and ghrelin concentrations. Am J Clin Nutr 82:41–48CrossRefGoogle Scholar