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.

 To counter 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 .

The Västerbotten 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 of age.

Diet  Intervention was the pivotal component of the program. 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 Project (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 years (86-92). During the same period a decrease in the numbers of strokes and myocardial infarctions were reported .

 However, a 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.

Reference:
Lena Nilsson et al.Nutrition Journal 2012, 11:40

Source-Medindia