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      Modelling the Effect of Compliance with Nordic Nutrition Recommendations on Cardiovascular Disease and Cancer Mortality in the Nordic Countries

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          Abstract

          The objective of this study is to estimate the number of deaths attributable to cardiovascular diseases and diet-related cancers that could be prevented or delayed in the Nordic countries, i.e., Sweden, Denmark, Finland, Norway, and Iceland, if adults adhere to the Nordic Nutrition Recommendations (NNR). A sex- and age-group specific epidemiological macro-simulation model was used to estimate the preventable deaths due to the differences between country specific actual intake and recommended intake of changes in food components. Data included in the model are a baseline scenario (actual dietary intake), a counterfactual scenario (recommended intake), and age-and sex-specific mortality for cardiovascular and diet-related cancer diseases, together with the total population risk of a specific year. Monte Carlo analyses with 5000 iterations were performed to produce the 95% uncertainty intervals. The model predicts that Iceland would benefit the most by adhering to the NNR, followed by Finland. In all the Nordic countries, the highest benefit would be achieved by adhering to the fruits and vegetable intakes, except Denmark, where a lower recommended intake of salt would provide the highest benefit. For men, fruits and vegetables could have saved more lives compared to other dietary components for all the Nordic countries, while for women, dietary fiber was the most prominent factor, except in Iceland. The Nordic Council should consider policies for promoting healthy eating according to the needs of each country.

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          Most cited references55

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          2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary

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            Limitations of the randomized controlled trial in evaluating population-based health interventions.

            Population- and systems-based interventions need evaluation, but the randomized controlled trial (RCT) research design has significant limitations when applied to their complexity. After some years of being largely dismissed in the ranking of evidence in medicine, alternatives to the RCT have been debated recently in public health and related population and social service fields to identify the trade-offs in their use when randomization is impractical or unethical. This review summarizes recent debates and considers the pragmatic and economic issues associated with evaluating whole-population interventions while maintaining scientific validity and credibility.
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              The EPIC nutrient database project (ENDB): a first attempt to standardize nutrient databases across the 10 European countries participating in the EPIC study.

              This paper describes the ad hoc methodological concepts and procedures developed to improve the comparability of Nutrient databases (NDBs) across the 10 European countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). This was required because there is currently no European reference NDB available. A large network involving national compilers, nutritionists and experts on food chemistry and computer science was set up for the 'EPIC Nutrient DataBase' (ENDB) project. A total of 550-1500 foods derived from about 37,000 standardized EPIC 24-h dietary recalls (24-HDRS) were matched as closely as possible to foods available in the 10 national NDBs. The resulting national data sets (NDS) were then successively documented, standardized and evaluated according to common guidelines and using a DataBase Management System specifically designed for this project. The nutrient values of foods unavailable or not readily available in NDSs were approximated by recipe calculation, weighted averaging or adjustment for weight changes and vitamin/mineral losses, using common algorithms. The final ENDB contains about 550-1500 foods depending on the country and 26 common components. Each component value was documented and standardized for unit, mode of expression, definition and chemical method of analysis, as far as possible. Furthermore, the overall completeness of NDSs was improved (>or=99%), particularly for beta-carotene and vitamin E. The ENDB constitutes a first real attempt to improve the comparability of NDBs across European countries. This methodological work will provide a useful tool for nutritional research as well as end-user recommendations to improve NDBs in the future.
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                Author and article information

                Journal
                Nutrients
                Nutrients
                nutrients
                Nutrients
                MDPI
                2072-6643
                25 June 2019
                June 2019
                : 11
                : 6
                : 1434
                Affiliations
                [1 ]Health Economics Unit, Department of Clinical Science (Malmö), Lund University, SE-22381 Lund, Sweden; ulf.gerdtham@ 123456med.lu.se
                [2 ]School of Economics and Management, Agrifood Economics Centre, Lund University, SE-22007 Lund, Sweden; jonas.nordstrom@ 123456agrifood.lu.se
                [3 ]Department of Food and Resource Economics, University of Copenhagen, DK-1958 Frederiksberg C, Denmark
                [4 ]National Food Agency, SE-75126 Uppsala, Sweden; evairene@ 123456live.se
                [5 ]Department of Internal Medicine, Skane University Hospital, SE-20502 Malmo, Sweden; peter.nilsson@ 123456med.lu.se
                [6 ]Department of Clinical Sciences (Malmo), Lund University, SE-20502 Malmo, Sweden
                [7 ]Department of Economics, Lund University, SE-22363 Lund, Sweden
                Author notes
                [* ]Correspondence: sanjib.saha@ 123456med.lu.se ; Tel.: +46-(0)-40-391424; Fax: +46-(0)-46-2224118
                Author information
                https://orcid.org/0000-0001-8649-0773
                Article
                nutrients-11-01434
                10.3390/nu11061434
                6627195
                31242671
                e6d4e26c-40c8-45b9-b12c-e8582980cbc5
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 23 May 2019
                : 21 June 2019
                Categories
                Article

                Nutrition & Dietetics
                nordic diet,nordic countries,dietary guidelines,macro simulation model,cardiovascular diseases,recommended intake,health benefit

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