A long -term study on a
north Swedish population revealed that
the decrease and increase in cholesterol levels changed with the
prevailing diet trends and that
these changes havea direct bearing on the management and prevention of CVD.
In the 1970s, it was observed that the prevalence of cardiovascular diseases (CVD) was the greatest in Swedish men living in
the northern part of Sweden, when compared
globally. CVD was the highest in Västerbotten area in northern Sweden
than anywhere else in the country.
this, a community-based prevention
programme was initiated in 1985, in the Norsjö municipality of Västerbotten county. Later on the program
was extended to the entire county .
Intervention Programme (VIP)
, which is still
being carried out , combined
community-oriented activities, such as food labelling system, health
information meetings and cooking
demonstrations with individual-oriented activities, such as health examinations and
counselling to those living in that area, upon reaching 30, 40, 50 and 60 years
Diet Intervention was the pivotal component of
The link between nutrition and health is
complicated, as it involves specific food components, their interactions with
genetic factors and the person's needs.
Concurrently, the two northern most Swedish counties of Västerbotten and Norrbotten, joined the WHO sponsored MONICA
(Multinational Monitoring of Trends and Determinants in Cardiovascular Diseases) . Data
collection that was carried out
for VIP and MONICA was co-ordinated to
allow comparison of data.
Incidentally, Data from the VIP and the MONICA together are considered one of the world's largest diet-based
databases in the world with the longest follow up. Information
on food and nutrient intake was
gathered based on self-reporting. Information regarding body weight, height
and serum cholesterol were gathered from more than 140,000 observations. Food
intake, lifestyle and health trends extending for 25 years was observed and
their contribution to fat intake, serum
cholesterol and BMI was evaluated.
During the study, Sweden was going through a period
when high protein, high fat and low
carbohydrate foods were being promoted as an effective means to achieve weight loss, to control glycemic levels and
to prevent type 2 diabetes. This hypothesis was given a lot of hype by the
media as well and plenty of Swedish folks were following this method.
After the community-based interventional programs
were implemented there appeared to be a change in the lifestyle trend of the concerned
population. The MONICA survey
reports that during the years between 1986-1999, changes in lifestyle was noted. There was a rapid
decline in fat intake, as high fat milk and butter were replaced with margarine and other low- fat products.
Smoking declined, but intake of alcoholic drinks and
use of snuff increased. Wine
consumption became very high in both men and women, and beer consumption in
men. No change in leisure-time physical activity was noted.
There was a considerable reduction in the
cholesterol levels in the first seven
(86-92). During the same period a decrease in the numbers of strokes and
myocardial infarctions were reported .
reversal was reported in the next six years
2004-2010 as there was a shift in dietary pattern, with a steady increase in
fat intake. Butter was used liberally, both as spread and also for
cooking. There was less consumption of
boiled potatoes and there was more consumption of rice, pasta and soft bread.
After 2007, there was an increase in cholesterol levels and BMI index, in both sexes, due to the intake of
monounsaturated and saturated fatty acids.
During this period high numbers of CVD mortality was reported.
It can be
concluded that the decrease and the increase in cholesterol changed with diet
trends in the studied Swedish populations. These changes in risk factors have a
direct bearing on the management and prevention of CVD.
Lena Nilsson et al.Nutrition Journal