title: Weight Loss, Glycemic Control, and Cardiovascular Disease Risk Factors in Response to Differential Diet Composition in a Weight Loss Program in Type 2 Diabetes: A Randomized Controlled Trial Low-fat, high-fiber diet favorably affects several independent risk markers of ischemic heart disease: observations on blood lipids, coagulation, and fibrinolysis from a trial of middle-aged Danes. 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. Health effect of the New Nordic Diet in adults with increased waist circumference: a 6-mo randomized controlled trial. Magnesium Intake in Relation to Systemic Inflammation, Insulin Resistance, and the Incidence of Diabetes Effects of school meals with weekly fish servings on vitamin D status in Danish children: secondary outcomes from the OPUS (Optimal well-being, development and health for Danish children through a healthy New Nordic Diet) School Meal Study The effects of Nordic school meals on concentration and school performance in 8- to 11-year-old children in the OPUS School Meal Study: a cluster-randomised, controlled, cross-over trial. Plate waste and intake of school lunch based on the new Nordic diet and on packed lunches: a randomised controlled trial in 8- to 11-year-old Danish children Diet-Induced Weight Loss Alters Functional Brain Responses during an Episodic Memory Task Dietary effects of introducing school meals based on the New Nordic Diet - a randomised controlled trial in Danish children. The OPUS School Meal Study. Adherence to a Healthy Nordic Food Index Is Associated with a Lower Risk of Type-2 Diabetes—The Danish Diet, Cancer and Health Cohort Study Plasma alkylresorcinols C17:0/C21:0 ratio, a biomarker of relative whole-grain rye intake, is associated to insulin sensitivity: a randomized study 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Influence of a prudent diet on circulating cathepsin S in humans Diet-induced changes in iron and n-3 fatty acid status and associations with cognitive performance in 8-11-year-old Danish children: secondary analyses of the Optimal Well-Being, Development and Health for Danish Children through a Healthy New Nordic Diet School Meal Study. Dietary fiber and the glycemic index: a background paper for the Nordic Nutrition Recommendations 2012 Effects of school meals based on the New Nordic Diet on intake of signature foods: a randomised controlled trial. The OPUS School Meal Study. Normotensive Women With Type 2 Diabetes and Microalbuminuria Are at High Risk for Macrovascular Disease A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. Dietary magnesium intake in relation to plasma insulin levels and risk of type 2 diabetes in women. Left ventricular remodelling changes without concomitant loss of myocardial fat after long-term dietary intervention. Influence of a healthy Nordic diet on serum fatty acid composition and associations with blood lipoproteins – results from the NORDIET study Accuracy of self-reported intake of signature foods in a school meal intervention study: comparison between control and intervention period. The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study Exchanging a few commercial, regularly consumed food items with improved fat quality reduces total cholesterol and LDL-cholesterol: a double-blind, randomised controlled trial. An eight-month controlled study of a low-fat high-fibre diet: effects on blood lipids and blood pressure in healthy young subjects. Serum and dietary magnesium and the risk for type 2 diabetes mellitus: the Atherosclerosis Risk in Communities Study. Beneficial effects of high dietary fiber intake in patients with type 2 diabetes mellitus. Long-term effects of a Palaeolithic-type diet in obese postmenopausal women: a 2-year randomized trial [Food intake of Danes and cardiac risk factors]. Design of the OPUS School Meal Study: A randomised controlled trial assessing the impact of serving school meals based on the New Nordic Diet Effects of a healthy Nordic diet on cardiovascular risk factors in hypercholesterolaemic subjects: a randomized controlled trial (NORDIET). Strong and persistent effect on liver fat with a Paleolithic diet during a two-year intervention Attenuated Low-Grade Inflammation Following Long-Term Dietary Intervention in Postmenopausal Women with Obesity. Plasma alkylresorcinols reflect important whole-grain components of a healthy Nordic diet.
abstract: OBJECTIVE To test whether a weight loss program promotes greater weight loss , glycemic control , and improved cardiovascular disease risk factors compared with control conditions and whether there is a differential response to higher versus lower carbohydrate intake . RESEARCH DESIGN AND METHODS This r and omized controlled trial at two university medical centers enrolled 227 overweight or obese adults with type 2 diabetes and assigned them to parallel in-person diet and exercise counseling , with prepackaged foods in a planned menu during the initial phase , or to usual care ( UC ; two weight loss counseling sessions and monthly contacts ) . RESULTS Relative weight loss was 7.4 % ( 95 % CI 5.7–9.2 % ) , 9.0 % ( 7.1–10.9 % ) , and 2.5 % ( 1.3–3.8 % ) for the lower fat , lower carbohydrate , and UC groups ( P < 0.001 intervention effect ) . Glycemic control markers and triglyceride levels were lower in the intervention groups compared with UC group at 1 year ( fasting glucose 141 [ 95 % CI 133–149 ] vs. 159 [ 144–174 ] mg/dL , P = 0.023 ; hemoglobin A1c 6.9 % [ 6.6–7.1 % ] vs. 7.5 % [ 7.1–7.9 % ] or 52 [ 49–54 ] vs. 58 [ 54–63 ] mmol/mol , P = 0.001 ; triglycerides 148 [ 134–163 ] vs. 204 [ 173–234 ] mg/dL , P < 0.001 ) . The lower versus higher carbohydrate groups maintained lower hemoglobin A1c ( 6.6 % [ 95 % CI 6.3–6.8 % ] vs. 7.2 % [ 6.8–7.5 % ] or 49 [ 45–51 ] vs. 55 [ 51–58 ] mmol/mol ) at 1 year ( P = 0.008 ) . CONCLUSIONS The weight loss program result ed in greater weight loss and improved glycemic control in type 2 diabetes We served a low-fat ( 28 % of energy ) , high-fiber ( 3.3 g/MJ ) diet according to Nordic nutrition recommendations ( Rec diet ) , and a high-fat diet ( 39 % of energy ) corresponding to the average Danish diet ( Dane diet ) for periods of 2 wk in a r and omized crossover study of 21 healthy middle-aged individuals . The Rec diet result ed in lower serum concentrations of low-density-lipoprotein ( LDL ) cholesterol ( medians : 2.77 vs 3.04 mmol/L , P < 0.001 ) and high-density-lipoprotein ( HDL ) cholesterol ( 1.08 vs 1.24 mmol/L , P < 0.001 ) , and higher fasting triglycerides ( 1.11 vs 0.86 mmol/L , P = 0.04 ) than did the Dane diet . Furthermore , the Rec diet lowered plasma factor VII coagulant activity ( FVIIc ) ( 88 % vs 96 % , P = 0.002 ) and raised plasma fibrinolytic activity . Our observations indicate that a low-fat , high-fiber diet may not only reduce the atherogenic but also the thrombogenic tendency of an individual compared with a diet corresponding to the average Danish diet BACKGROUND Ad libitum , low-carbohydrate diets decrease caloric intake and cause weight loss . It is unclear whether these effects are due to the reduced carbohydrate content of such diets or to their associated increase in protein intake . OBJECTIVE We tested the hypothesis that increasing the protein content while maintaining the carbohydrate content of the diet lowers body weight by decreasing appetite and spontaneous caloric intake . DESIGN Appetite , caloric intake , body weight , and fat mass were measured in 19 subjects placed sequentially on the following diets : a weight-maintaining diet ( 15 % protein , 35 % fat , and 50 % carbohydrate ) for 2 wk , an isocaloric diet ( 30 % protein , 20 % fat , and 50 % carbohydrate ) for 2 wk , and an ad libitum diet ( 30 % protein , 20 % fat , and 50 % carbohydrate ) for 12 wk .  Blood was sample d frequently at the end of each diet phase to measure the area under the plasma concentration versus time curve ( AUC ) for insulin , leptin , and ghrelin . RESULTS Satiety was markedly increased with the isocaloric high-protein diet despite an unchanged leptin AUC . Mean ( + /-SE ) spontaneous energy intake decreased by 441 + /- 63 kcal/d , body weight decreased by 4.9 + /- 0.5 kg , and fat mass decreased by 3.7 + /- 0.4 kg with the ad libitum , high-protein diet , despite a significantly decreased leptin AUC and increased ghrelin AUC . CONCLUSIONS An increase in dietary protein from 15 % to 30 % of energy at a constant carbohydrate intake produces a sustained decrease in ad libitum caloric intake that may be mediated by increased central nervous system leptin sensitivity and results in significant weight loss . This anorexic effect of protein may contribute to the weight loss produced by low-carbohydrate diets BACKGROUND The regional Mediterranean Diet has been associated with lower risk of disease . OBJECTIVE We tested the health effects of the New Nordic Diet ( NND ) , which is a gastronomically driven regional , organic , and environmentally friendly diet , in a carefully controlled but free-living setting . DESIGN A total of 181 central ly obese men and women , with a mean ( range ) age of 42 y ( 20 - 66 y ) , body mass index ( in kg/m(2 ) ) of 30.2 ( 22.6 - 47.3 ) , and waist circumference of 100 cm ( 80 - 138 cm ) were r and omly assigned to receive either the NND ( high in fruit , vegetables , whole grains , and fish ) or an average Danish diet ( ADD ) for 26 wk . Participants received cookbooks and all foods ad libitum and free of charge by using a shop model . The primary endpoint was the weight change analyzed by both completer and intention-to-treat analyses . RESULTS A total of 147 subjects [ 81 % ( NND 81 % ; ADD 82 % ) ] completed the intervention . A high dietary compliance was achieved , with significant differences in dietary intakes between groups . The mean ( ±SEM ) weight change was -4.7 ± 0.5 kg for the NND compared with -1.5 ± 0.5 kg for the ADD ( adjusted difference : -3.2 kg ; 95 % CI : -4.6 , -1.8 kg ; P < 0.001 ) for the completer analysis , and the difference was -3.0 kg ( 95 % CI : -4.0 , -2.1 kg ) for the intention-to-treat analysis . The NND produced greater reductions in systolic blood pressure ( adjusted difference : -5.1 mm Hg ; 95 % CI : -8.2 , -2.1 mm Hg ) and diastolic blood pressure ( adjusted difference : -3.2 mm Hg ; 95 % CI : -5.7 , -0.8 mm Hg ) than did the ADD . CONCLUSION An ad libitum NND produces weight loss and blood pressure reduction in central ly obese individuals . This trial was registered at www . clinical trials.gov as NCT01195610 OBJECTIVE To investigate the long-term associations of magnesium intake with incidence of diabetes , systemic inflammation , and insulin resistance among young American adults . RESEARCH DESIGN AND METHODS A total of 4,497 Americans , aged 18–30 years , who had no diabetes at baseline , were prospect ively examined for  incident diabetes based on quintiles of magnesium intake . We also investigated the associations between magnesium intake and inflammatory markers , i.e. , high-sensitivity C-reactive protein ( hs-CRP ) , interleukin-6 ( IL-6 ) , and fibrinogen , and the homeostasis model assessment of insulin resistance ( HOMA-IR ) . RESULTS During the 20-year follow-up , 330 incident cases of diabetes were identified . Magnesium intake was inversely associated with incidence of diabetes after adjustment for potential confounders . The multivariable-adjusted hazard ratio of diabetes for participants in the highest quintile of magnesium intake was 0.53 ( 95 % CI , 0.32–0.86 ; Ptrend < 0.01 ) compared with those in the lowest quintile . Consistently ,  magnesium  intake was significantly inversely associated with hs-CRP , IL-6 , fibrinogen , and HOMA-IR , and serum magnesium levels were inversely correlated with hs-CRP and HOMA-IR . CONCLUSIONS Magnesium intake was inversely longitudinally associated with incidence of diabetes in young American adults . This inverse association may be explained , at least in part , by the inverse correlations of magnesium intake with systemic inflammation and insulin resistance Children 's vitamin D intake and status can be optimised to meet recommendations . We investigated if nutritionally balanced school meals with weekly fish servings affected serum 25-hydroxyvitamin D ( 25(OH)D ) and markers related to bone in 8- to 11-year-old Danish children . We conducted an explorative secondary outcome analysis on data from 784 children from the OPUS School Meal Study , a cluster-r and omised cross-over trial where children received school meals for 3 months and habitual lunch for 3 months . At baseline , and at the end of each dietary period , 25(OH)D , parathyroid hormone ( PTH ) , osteocalcin ( OC ) , insulin-like growth factor-1 ( IGF-1 ) , bone mineral content ( BMC ) , bone area ( BA ) , bone mineral density ( BMD ) , dietary intake and physical activity were assessed . School meals increased vitamin D intake by 0·9 ( 95 % CI 0·7 , 1·1 ) μg/d . No consistent effects were found on 25(OH)D , BMC , BA , BMD , IGF-1 or OC . However , season-modified effects were observed with 25(OH)D , i.e. children completing the school meal period in January/February had higher 25(OH)D status ( 5·5 ( 95 % CI 1·8 , 9·2 ) nmol/l ; P = 0·004 ) than children completing the control period in these months . A similar tendency was indicated in November/December ( 4·1 ( 95 % CI –0·12 , 8·3 ) nmol/l ; P = 0·057 ) . However , the effect was opposite in March/April ( –4·0 ( 95 % CI –7·0 , –0·9 ) nmol/l ; P = 0·010 ) , and no difference was found in May/June ( P = 0·214 ) . Unexpectedly , the school meals slightly increased PTH ( 0·18 ( 95 % CI 0·07 , 0·29 ) pmol/l ) compared with habitual lunch . Small increases in dietary vitamin D might hold potential to mitigate the winter nadir in Danish children 's 25(OH)D status while higher increases appear necessary to affect status throughout the year . More trials on effects of vitamin D intake from natural foods are needed It is widely assumed that nutrition can improve school performance in children ; however , evidence remains limited and inconclusive . In the present study , we investigated whether serving healthy school meals influenced concentration and school performance of 8- to 11-year-old Danish children . The OPUS ( Optimal well-being , development and health for Danish children through a healthy New Nordic Diet ) School Meal Study was a cluster-r and omised , controlled , cross-over trial comparing a healthy school meal programme with the usual packed lunch from home ( control ) each for 3 months ( NCT 01457794 ) . The d2 test of attention , the Learning Rating Scale ( LRS ) and st and ard tests on reading and mathematics proficiency were administered at baseline and at the end of each study period . Intervention effects were evaluated using hierarchical mixed models . The school meal intervention did not influence concentration performance ( CP ; primary outcome , n 693 ) or processing speed ; however , the decrease in error percentage was 0·18 points smaller ( P<0·001 ) in the intervention period than in the control period ( medians : baseline 2·03 % ; intervention 1·46 % ; control 1·37 % ) . In contrast , the intervention increased reading speed ( 0·7 sentence , P=0·009 ) and the number of correct sentences ( 1·8 sentences , P<0·001 ) , which corresponded to 11 and 25 % , respectively , of the effect of one school year . The percentage of correct sentences also improved ( P<0·001 ) , indicating that the number correct improved relatively more than reading speed . There was no effect on overall math performance or outcomes from the LRS . In conclusion , school meals did not affect CP , but improved reading performance , which is a complex cognitive activity that involves inference , and increased errors related to impulsivity and inattention . These findings are worth examining in future trials The aim of the present study was to compare total food intake , total and relative edible plate waste and self-reported food likings between school lunch based on the new Nordic diet ( NND ) and packed lunch from home . In two 3-month periods in a cluster-r and omised controlled unblinded cross-over study 3rd- and 4th- grade children ( n 187 ) from two municipal schools received lunch meals based on NND principles and their usual packed lunch ( control ) .  Food intake and plate waste ( n 1558 ) were calculated after weighing lunch plates before and after the meal for five consecutive days and self-reported likings ( n 905 ) assessed by a web-based question naire . Average food intake was 6 % higher for the NND period compared with the packed lunch period . The quantity of NND intake varied with the menu ( P < 0·0001 ) and was positively associated with self-reported likings . The edible plate waste was 88 ( sd 80 ) g for the NND period and 43 ( sd 60 ) g for the packed lunch period whereas the relative edible plate waste was no different between periods for meals having waste ( n 1050 ) . Edible plate waste differed between menus ( P < 0·0001 ) , with more waste on soup days ( 36 % ) and vegetarian days ( 23 % ) compared with the packed lunch period . Self-reported likings were negatively associated with percentage plate waste ( P < 0·0001 ) . The study suggests that portion sizes need to be considered in new school meal programmes . New strategies with focus on reduction of plate waste , children 's likings and nutritious school meals are crucial from both a nutritional , economic and environmental point of view Objective : It has been suggested that overweight is negatively associated with cognitive functions . The aim of this study was to investigate whether a reduction in body weight by dietary interventions could improve episodic memory performance and alter associated functional brain responses in overweight and obese women . Methods : 20 overweight postmenopausal women were r and omized to either a modified paleolithic diet or a st and ard diet adhering to the Nordic Nutrition Recommendations for 6 months . We used functional magnetic resonance imaging to examine brain function during an episodic memory task as well as anthropometric and biochemical data before and after the interventions . Results : Episodic memory performance improved significantly ( p = 0.010 ) after the dietary interventions . Concomitantly , brain activity increased in the anterior part of the right hippocampus during memory encoding , without differences between diets . This was associated with decreased levels of plasma free fatty acids ( FFA ) . Brain activity increased in pre-frontal cortex and superior/middle temporal gyri . The magnitude of increase correlated with waist circumference reduction . During episodic retrieval , brain activity decreased in inferior and middle frontal gyri , and increased in middle/superior temporal gyri . Conclusions : Diet-induced weight loss , associated with decreased levels of plasma FFA , improves episodic memory linked to increased hippocampal activity The OPUS ( Optimal well-being , development and health for Danish children through a healthy New Nordic Diet ( NND ) ) School Meal Study investigated the effects on the intake of foods and nutrients of introducing school meals based on the principles of the NND covering lunch and all snacks during the school day in a cluster-r and omised cross-over design . For two 3-month periods , 834 Danish children aged 8 - 11 years from forty-six school classes at nine schools received NND school meals or their usual packed lunches brought from home ( control ) in r and om order . The whole diet of the children was recorded over seven consecutive days using a vali date d Web-based Dietary Assessment Software for Children . The NND result ed in higher intakes of potatoes ( 130 % , 95 % CI 2·07 , 2·58 ) , fish ( 48 % , 95 % CI 1·33 , 1·65 ) , cheese ( 25 % , 95 % CI 1·15 , 1·36 ) , vegetables ( 16 % , 95 % CI 1·10 , 1·21 ) , eggs ( 10 % , 95 % CI 1·01 , 1·19 ) and beverages ( 6 % , 95 % CI 1·02 , 1·09 ) , and lower intakes of bread ( 13 % , 95 % CI 0·84 , 0·89 ) and fats ( 6 % , 95 % CI 0·90 , 0·98 ) were found among the children during the NND period than in the control period ( all , P < 0·05 ) . No difference was found in mean energy intake ( P= 0·4 ) , but on average children reported 0·9 % less energy intake from fat and 0·9 % higher energy intake from protein during the NND period than in the control period . For micronutrient intakes , the largest differences were found for vitamin D ( 42 % , 95 % CI 1·32 , 1·53 ) and iodine ( 11 % , 95 % CI 1·08 , 1·15 ) due to the higher fish intake . In conclusion , the present study showed that the overall dietary intake at the food and nutrient levels was improved among children aged 8 - 11 years when their habitual packed lunches were replaced by school meals following the principles of the NND Background : Type-2 diabetes ( T2D ) prevalence is rapidly increasing worldwide . Lifestyle factors , in particular obesity , diet , and physical activity play a significant role in the etiology of the disease . Of dietary patterns , particularly the Mediterranean diet has been studied , and generally a protective association has been identified . However , other regional diets are less explored . Objective : The aim of the present study was to investigate the association between adherence to a healthy Nordic food index and the risk of T2D . The index consists of six food items : fish , cabbage , rye bread , oatmeal , apples and pears , and root vegetables . Methods : Data was obtained from a prospect i ve cohort study of 57,053 Danish men and women aged 50–64 years , at baseline , of whom 7366 developed T2D ( median follow-up : 15.3 years ) . The Cox proportional hazards model was used to assess the association between the healthy Nordic food index and risk of T2D , adjusted for potential confounders . Results : Greater adherence to the  healthy Nordic food index was significantly associated with lower risk of T2D after adjusting for potential confounders . An index score of 5−6 points ( high adherence ) was associated with a statistically significantly 25 % lower T2D risk in women ( HR : 0.75 , 95%CI : 0.61–0.92 ) and 38 % in men ( HR : 0.62 ; 95%CI : 0.53–0.71 ) compared to those with an index score of 0 points ( poor adherence ) . Conclusion : Adherence to a healthy Nordic food index was found to be inversely associated with risk of T2D , suggesting that regional diets other than the Mediterranean may also be recommended for prevention of T2D Background / Objectives : Few studies have used biomarkers of whole-grain intake to study its relation to glucose metabolism . We aim ed to investigate the association between plasma alkylresorcinols ( AR ) , a biomarker of whole-grain rye and wheat intake , and glucose metabolism in individuals with metabolic syndrome (MetS).Subjects/ Methods : Participants were 30–65 years of age , with body mass index 27–40 kg/m2 and had MetS without diabetes . Individuals were recruited through six centers in the Nordic countries and r and omized to a healthy Nordic diet ( ND , n=96 ) , rich in whole-grain rye and wheat , or a control diet ( n=70 ) , for 18–24 weeks . In addition , associations between total plasma AR concentration and C17:0/C21:0 homolog ratio as an indication of the relative whole-grain rye intake , and glucose metabolism measures from oral glucose tolerance tests were investigated in pooled ( ND+control ) regression analyses at 18/24 weeks . Results : ND did not improve glucose metabolism compared with control diet , but the AR C17:0/C21:0 ratio was inversely associated with fasting insulin concentrations ( P=0.002 ) and positively associated with the insulin sensitivity indices Matsuda ISI ( P=0.026 ) and disposition index ( P=0.022 ) in pooled analyses at 18/24 weeks , even after adjustment for confounders . The AR C17:0/C21:0 ratio was not significantly associated with insulin secretion indices . Total plasma AR concentration was not related to fasting plasma glucose or fasting insulin at 18/24 weeks . Conclusions : The AR C17:0/C21:0 ratio , an indicator of relative whole-grain rye intake , is associated with increased insulin sensitivity in a population with BACKGROUND In the 2.8 years of the Diabetes Prevention Program ( DPP ) r and omised clinical trial ,  diabetes incidence  in high-risk adults was reduced by 58 % with intensive lifestyle intervention and by 31 % with metformin , compared with placebo . We investigated the persistence of these effects in the long term . METHODS All active DPP participants were eligible for continued follow-up . 2766 of 3150 ( 88 % ) enrolled for a median additional follow-up of 5.7 years ( IQR 5.5 - 5.8 ) . 910 participants were from the lifestyle , 924 from the metformin , and 932 were from the original placebo groups .  On the basis of the benefits from the intensive lifestyle intervention in the DPP , all three groups were offered group-implemented lifestyle intervention . Metformin treatment was continued in the original metformin group ( 850 mg twice daily as tolerated ) , with participants unmasked to assignment , and the original lifestyle intervention group was offered additional lifestyle support . The primary outcome was development of diabetes according to American Diabetes Association criteria . Analysis was by intention-to-treat . This study is registered with Clinical Trials.gov , number NCT00038727 . FINDINGS During the 10.0-year ( IQR 9.0 - 10.5 ) follow-up since r and omisation to DPP , the original lifestyle group lost , then partly regained weight . The modest weight loss with metformin was maintained . Diabetes incidence rates during the DPP were 4.8 cases per 100 person-years ( 95 % CI 4.1 - 5.7 ) in the intensive lifestyle intervention group , 7.8 ( 6.8 - 8.8 ) in the metformin group , and 11.0 ( 9.8 - 12.3 ) in the placebo group . Diabetes incidence rates in this follow-up study were similar between treatment groups : 5.9 per 100 person-years ( 5.1 - 6.8 ) for lifestyle , 4.9 ( 4.2 - 5.7 ) for metformin , and 5.6 ( 4.8 - 6.5 ) for placebo . Diabetes incidence in the 10 years since DPP r and omisation was reduced by 34 % ( 24 - 42 ) in the lifestyle group and 18 % ( 7 - 28 ) in the metformin group compared with placebo . INTERPRETATION During follow-up after DPP , incidences in the former placebo and metformin groups fell to equal those in the former lifestyle group , but the cumulative incidence of diabetes remained lowest in the lifestyle group . Prevention or delay of diabetes with lifestyle intervention or metformin can persist for at least 10 years . FUNDING National Institute of Diabetes and Digestive and Kidney Diseases ( NIDDK ) Background Increased circulating cathepsin S levels have been linked to increased risk of cardiometabolic diseases and cancer . However , whether cathepsin S is a modifiable risk factor is unclear . We aim ed to investigate the effects of a prudent diet on plasma cathepsin S levels in healthy individuals . Findings Explorative analyses of a r and omized study were performed in 88 normal to slightly overweight and hyperlipidemic men and women ( aged 25 to 65 ) that were r and omly assigned to ad libitum prudent diet , i.e. healthy Nordic diet ( ND ) or a control group ( habitual Western diet ) for 6 weeks . Whereas all foods in the ND were provided , the control group was advised to consume their habitual diet throughout the study . The ND was in line with dietary recommendations , e.g. low in saturated fats , sugars and salt , but high in plant-based foods rich in fibre and unsaturated fats . The ND significantly decreased cathepsin S levels ( from 20.1 ( + /-4.0 SD ) to 19.7 μg/L ( + /-4.3 SD ) ) compared with control group ( from 18.2 ( + /-2.9 SD ) to 19.1 μg/L ( + /-3.8 SD ) ) . This difference remained after adjusting for sex and change in insulin sensitivity ( P = 0.03 ) , and near significant after adjusting for baseline cathepsin S levels ( P = 0.06 ) , but not for change in weight or LDL-C. Changes in cathepsin S levels were directly correlated with change in LDL-C. Conclusions Compared with a habitual control diet , a provided ad libitum healthy Nordic diet decreased cathepsin S levels in healthy individuals , possibly mediated by weight loss or lowered LDL-C. These differences between groups in cathepsin S were however not robust and therefore need further investigation Fe and n-3 long-chain PUFA ( n-3 LCPUFA ) have both been associated with cognition , but evidence remains inconclusive in well-nourished school-aged children . In the Optimal Well-Being , Development and Health for Danish Children through a Healthy New Nordic Diet ( OPUS ) School Meal Study , the 3-month intervention increased reading performance , inattention , impulsivity and dietary intake of fish and Fe . This study investigated whether the intervention influenced n-3 LCPUFA and Fe status and , if so , explored how these changes correlated with the changes in cognitive performance . The study was a cluster-r and omised cross-over trial comparing school meals with packed lunch ( control ) . At baseline and after each treatment , we measured serum ferritin , whole-blood n-3 LCPUFA and Hb , and performance in reading , mathematics and d2-test of attention . Data were analysed using mixed models ( n 726 ) and principal component analysis of test performances ( n 644 ) , which showed two main patterns : ' school performance ' and ' reading comprehension ' . The latter indicated that children with good reading comprehension were also more inattentive and impulsive ( i.e. higher d2-test error% ) . The intervention improved ' school performance ' ( P=0·015 ) , ' reading comprehension ' ( P=0·043 ) and EPA+DHA status 0·21 ( 95 % CI 0·15 , 0·27 ) w/w % ( P<0·001 ) , but it did not affect serum ferritin or Hb . At baseline , having small Fe stores was associated with poorer ' school performance ' in girls , but with better ' reading comprehension ' in both boys and girls . Both baseline EPA+DHA status and the intervention-induced increase in EPA+DHA status was positively associated with ' school performance ' , suggesting that n-3 LCPUFA could potentially explain approximately 20 % of the intervention effect . These exploratory associations indicate that increased fish intake might explain some of the increase in reading performance and inattention in the study The aim of this study is to review recent data on dietary fiber ( DF ) and the glycemic index ( GI ) , with special focus on studies from the Nordic countries regarding cardiometabolic risk factors , type 2 diabetes , cardiovascular disease , cancer , and total mortality . In this study , recent guidelines and scientific background papers or up date s on older reports on DF and GI published between 2000 and 2011 from the US , EU , WHO , and the World Cancer Research Fund were review ed , as well as prospect i ve cohort and intervention studies carried out in the Nordic countries . All of the reports support the role for fiber-rich foods and DF as an important part of a healthy diet . All of the five identified Nordic papers found protective associations between high intake of DF and health outcomes ; lower risk of cardiovascular disease , type 2 diabetes , colorectal and breast cancer . None of the reports and few of the Nordic papers found clear evidence for the GI in prevention of risk factors or diseases in healthy population s , although association was found in sub-groups , e.g. overweight and obese individuals and suggestive for prevention of type 2 diabetes . It was concluded that DF is associated with decreased risk of different chronic diseases and metabolic conditions . There is not enough evidence that choosing foods with low GI will decrease the risk of chronic diseases in the population overall . However , there is suggestive evidence that ranking food based on their GI might be of use for overweight and obese individuals . Issues regarding methodology , validity and practicality of the GI remain to be clarified A New Nordic Diet ( NND ) was developed in the context of the Danish OPUS Study ( Optimal well-being , development and health for Danish children through a healthy New Nordic Diet ) . Health , gastronomic potential , sustainability and Nordic identity were crucial principles of the NND . The aim of the present study was to investigate the effects of serving NND school meals compared with the usual packed lunches on the dietary intake of NND signature foods . For two 3-month periods , 834 Danish children aged 8 - 11 years received NND school meals or their usual packed lunches brought from home ( control ) in r and om order . The entire diet was recorded over 7 consecutive days using a vali date d Web-based Dietary Assessment Software for Children . The NND result ed in higher intakes during the entire week ( % increase ) of root vegetables ( 116 ( 95 % CI 1·93 , 2·42 ) ) , cabbage ( 26 ( 95 % CI 1·08 , 1·47 ) ) , legumes ( 22 ( 95 % CI 1·06 , 1·40 ) ) , herbs ( 175 ( 95 % CI 2·36 , 3·20 ) ) , fresh berries ( 48 ( 95 % CI 1·13 , 1·94 ) ) , nuts and seeds ( 18 ( 95 % CI 1·02 , 1·38 ) ) , lean fish and fish products ( 47 ( 95 % CI 1·31 , 1·66 ) ) , fat fish and fish products ( 18 ( 95 % CI 1·02 , 1·37 ) ) and potatoes ( 129 ( 95 % CI 2·05 , 2·56 ) ) . Furthermore , there was a decrease in the number of children with zero intakes when their habitual packed lunches were replaced by NND school meals . In conclusion , this study showed that the children increased their intake of NND signature foods , and , furthermore , there was a decrease in the number of children with zero intakes of NND signature foods when their habitual packed lunches were replaced by school meals following the NND principles OBJECTIVE —The excess risk of macrovascular disease and death associated with diabetes seems higher in women than in men . The pathogenesis for this risk difference has not been fully eluci date d. We investigated whether female sex was associated with macrovascular disease and death , independently of known risk factors related to type 2 diabetes , nephropathy , or retinopathy in normotensive patients with type 2 diabetes and microalbuminuria . RESEARCH DESIGN AND METHODS —We conducted a prospect i ve , prolonged follow-up study of a subgroup of 67 diabetic patients ( 46 men and 21 women ) without established cardiovascular disease who participated in a larger clinical trial . Data were collected on current and past health , medication use , blood pressure , renal function , and HbA1c  during the follow-up period of 4.7 ± 0.8 ( means ± SE ) years . The end point was a composite of death , cardiovascular disease , cerebrovascular events , and peripheral artery disease . RESULTS —Of the women , eight ( 38.1 % ) met the end point compared with six ( 13.4 % ) of the men ( P = 0.02 for difference in event-free survival ) . The hazard ratio of women relative to men was 3.19 ( 95 % CI 1.11–9.21 ) , which further increased after adjusting for age , systolic blood pressure , BMI , smoking , total-to-HDL cholesterol ratio , urinary albumin excretion , and retinopathy . CONCLUSIONS —In our study population of normotensive patients with type 2 diabetes and microalbuminuria , female sex was associated with increased risk of fatal and nonfatal cardiovascular disease , independent of the classical cardiovascular risk factors , the severity of nephropathy or presence of retinopathy , or health care utilization BACKGROUND Type 2 diabetes mellitus is increasingly common , primarily because of increases in the prevalence of a sedentary lifestyle and obesity . Whether type 2 diabetes can be prevented by interventions that affect the lifestyles of subjects at high risk for the disease is not known . METHODS We r and omly assigned 522 middle-aged , overweight subjects ( 172 men and 350 women ; mean age , 55 years ; mean body-mass index [ weight in kilograms divided by the square of the height in meters ] , 31 ) with impaired glucose tolerance to either the intervention group or the control group . Each subject in the intervention group received individualized counseling aim ed at reducing weight , total intake of fat , and intake of saturated fat and increasing intake of fiber and physical activity . An oral glucose-tolerance test was performed annually ; the diagnosis of diabetes was confirmed by a second test . The mean duration of follow-up was 3.2 years . RESULTS The mean ( + /-SD ) amount of weight lost between base line and the end of year 1 was 4.2+/-5.1 kg in the intervention group and 0.8+/-3.7 kg in the control group ; the net loss by the end of year 2 was 3.5+/-5.5 kg in the intervention group and 0.8+/-4.4 kg in the control group ( P<0.001 for both comparisons between the groups ) . The cumulative incidence of diabetes after four years was 11 percent ( 95 percent confidence interval , 6 to 15 percent ) in the intervention group and 23 percent ( 95 percent confidence interval , 17 to 29 percent ) in the control group . During the trial , the risk of diabetes was reduced by 58 percent ( P<0.001 ) in the intervention group . The reduction in the incidence of diabetes was directly associated with changes in lifestyle . CONCLUSIONS Type 2 diabetes can be prevented by changes in the lifestyles of high-risk subjects OBJECTIVE Higher intake of magnesium appears to improve glucose and insulin homeostasis ; however , there are sparse prospect i ve data on the association between magnesium intake and incidence of type 2 diabetes . RESEARCH DESIGN AND METHODS In the Women 's Health Study , a cohort of 39,345 U.S. women aged > /=45 years with no previous history of cardiovascular disease , cancer , or type 2 diabetes completed vali date d semiquantitative food frequency question naires in 1993 and were followed for an average of 6 years . We used Cox proportional hazard models to estimate multivariate relative risks ( RRs ) of type 2 diabetes across quintiles of magnesium intake compared with the lowest quintile . In a sample of 349 apparently healthy women from this study , we measured plasma fasting insulin levels to examine their relation to magnesium intake . RESULTS During 222,523 person-years of follow-up , we documented 918 confirmed incident cases of type 2 diabetes . There was a significant inverse association between  magnesium intake and risk of type 2 diabetes , independent of age and BMI ( P = 0.007 for trend ) . After further adjustment for physical activity , alcohol intake , smoking , family history of diabetes , and total calorie intake , the multivariate-adjusted RRs of diabetes from the lowest to highest quintiles of magnesium intake were attenuated at 1.0 , 1.06 , 0.81 , 0.86 , and 0.89 ( P = 0.05 for trend ) . Among women with BMI > /=25 kg/m2 , the inverse trend was significant ; multivariate-adjusted RRs were 1.0 , 0.96 , 0.76 , 0.84 , and 0.78 ( P = 0.02 for trend ) . Multivariate-adjusted geometric mean insulin levels for overweight women in the lowest quartile of magnesium intake was 53.5 compared with 41.5 pmol/l among those at the highest quartile ( P = 0.03 for trend ) . CONCLUSIONS These findings support a protective role of higher intake of magnesium in reducing the risk of developing type 2 diabetes , especially in overweight women BACKGROUND Accumulation of myocardial triglycerides ( MTG ) is associated with impaired left ventricular ( LV ) remodelling and function in obese and diabetic subjects . The role of MTG accumulation in development of heart failure in this group of patients is unknown . Short-term studies suggest that diets that lead to weight loss could mobilize MTG , with a favourable effect on cardiac remodelling . In a 24-month , r and omized , investigator-blinded study , we assessed the effect of two different diets and subsequent weight loss on cardiac function and MTG in postmenopausal women . METHODS Sixty-eight healthy postmenopausal women with body mass index [ BMI ] ≥27kg/m(2 ) were  r and omized to an ad libitum Palaeolithic diet ( PD ) or a Nordic Nutrition Recommendation ( NNR ) diet for 24months  . Morphology , cardiac function , and MTG levels were measured using magnetic resonance ( MR ) scanning , including proton spectroscopy at baseline and 6 and 24months . RESULTS Despite mean weight losses of 4.9 ( 1.0 ) kg ( NNR ) and 7.8 ( 1.1 ) kg ( PD ) , the MTG content did not change over time ( p=0.98 in the NNR and p=0.11 in the PD group at 24months ) . Reduced left ventricular mass was observed in both diet groups over 24months . Blood pressure was reduced at 6months , but returned to baseline levels at 24months . End diastolic volume , stroke volume , and cardiac output decreased over time . No differences between diet groups were observed . CONCLUSIONS Diet intervention  and moderate weight loss over 24months improved LV remodelling but did not alter MTG levels in overweight/obese postmenopausal women Background The fatty acid ( FA ) composition of serum lipids is related to the quality of dietary fat intake . Objective To investigate the effects of a  healthy Nordic diet ( ND ) on the FA composition of serum cholesterol esters ( CE-FA ) and assess the associations between changes in the serum CE-FA composition and blood lipoproteins during a controlled dietary intervention . Design The NORDIET trial was a 6-week r and omised , controlled , parallel-group dietary intervention study that included 86 adults ( 53±8 years ) with elevated low-density lipoprotein cholesterol ( LDL-C ) . Serum CE-FA composition was measured using gas chromatography . Diet history interviews were conducted , and daily intake was assessed using checklists . Results Food and nutrient intake data indicated that there was a reduction in the intake of fat from dairy and meat products and an increase in the consumption of fatty fish with the ND . The levels of saturated fatty acids in cholesterol esters ( CE-SFA ) 14:0 , 15:0 , and 18:0 , but not 16:0 , showed a significant decrease after intake of ND compared to the control diet ( p<0.01 ) . Also , a significant increase in serum 22:6n – 3 was observed compared with the control diet ( p<0.01 ) . The changes in CE-SFA 14:0 , 15:0 , and 18:0 correlated positively with changes in LDL-C , HDL-C , LDL-C/HDL-C , ApoA1 , and ApoB ( p<0.01 ) , respectively , whereas the changes in polyunsaturated fatty acids in cholesterol esters ( CE-PUFA ) 22:6n – 3 were negatively correlated with changes in the corresponding serum lipids . Conclusions The decreased intake of saturated fat and increased intake of n-3 PUFA in a  healthy ND is partly reflected by changes in the serum CE-FA composition , which are associated with an improved serum lipoprotein pattern Bias in self-reported dietary intake is important when evaluating the effect of dietary interventions , particularly for intervention foods . However , few have investigated this in children , and none have investigated the reporting accuracy  of fish intake in children using biomarkers . In a Danish school meal study , 8- to 11-year-old children ( n 834 ) were served the New Nordic Diet ( NND ) for lunch . The present study examined the accuracy of  self-reported intake  of signature foods ( berries , cabbage , root vegetables , legumes , herbs , potatoes , wild plants , mushrooms , nuts and fish ) characterising the NND . Children , assisted by parents , self-reported their diet in a Web-based Dietary Assessment Software for Children during the intervention and control ( packed lunch ) periods . The reported fish intake by children was compared with their ranking according to fasting whole-blood EPA and DHA concentration and weight percentage using the Spearman correlations and cross-classification . Direct observation of school lunch intake ( n 193 ) was used to score the accuracy of food-reporting as matches , intrusions , omissions and faults . The reporting of all lunch foods had higher percentage of matches compared with the reporting of signature foods in both periods , and the accuracy was higher during the control period compared with the intervention period . Both Spearman 's rank correlations and linear mixed models demonstrated positive associations between EPA+DHA and reported fish intake . The direct observations showed that both reported and real intake of signature foods did increase during the intervention period . In conclusion , the self-reported data represented a true increase in the intake of signature foods and can be used to examine dietary intervention effects BACKGROUND Intensive lifestyle interventions can reduce the incidence of  type 2 diabetes in people with impaired glucose tolerance , but how long these benefits extend beyond the period of active intervention , and whether such interventions reduce the risk of cardiovascular disease ( CVD ) and mortality , is unclear . We aim ed to assess whether intensive lifestyle interventions have a long-term effect on the risk of diabetes , diabetes-related macrovascular and microvascular complications , and mortality . METHODS In 1986 , 577 adults with impaired glucose tolerance from 33 clinics in China were r and omly assigned to either the  control group or to one of three lifestyle intervention groups ( diet , exercise , or diet plus exercise ) . Active intervention took place over 6 years until 1992 . In 2006 , study participants were followed-up to assess the long-term effect of the interventions . The primary outcomes were diabetes incidence , CVD incidence and mortality , and all-cause mortality . FINDINGS Compared with control participants , those in the combined lifestyle intervention groups had a 51 % lower incidence of diabetes ( hazard rate ratio [ HRR ] 0.49 ; 95 % CI 0.33 - 0.73 ) during the active intervention period and a 43 % lower incidence ( 0.57 ; 0.41 - 0.81 ) over the 20 year period , controlled for age and clustering by clinic . The average annual incidence of diabetes was 7 % for intervention participants versus 11 % in control participants , with 20-year cumulative incidence of 80 % in the intervention groups and 93 % in the control group . Participants in the intervention group spent an average of 3.6 fewer years with diabetes than those in the control group . There was no significant difference between the intervention and control groups in the rate of first CVD events ( HRR 0.98 ; 95 % CI 0.71 - 1.37 ) , CVD mortality ( 0.83 ; 0.48 - 1.40 ) , and all-cause mortality ( 0.96 ; 0.65 - 1.41 ) , but our study had limited statistical power to detect differences for these outcomes . INTERPRETATION Group-based lifestyle interventions over 6 years can prevent or delay diabetes for up to 14 years after the active intervention . However , whether lifestyle intervention also leads to reduced CVD and mortality remains unclear The healthy Nordic diet has been previously shown to have health beneficial effects among subjects at risk of CVD . However , the extent of food changes needed to achieve these effects is less explored . The aim of the present study was to investigate the effects of exchanging a few commercially available , regularly consumed key food items ( e.g. spread on bread , fat for cooking , cheese , bread and cereals ) with improved fat quality on total cholesterol , LDL-cholesterol and inflammatory markers in a double-blind r and omised , controlled trial . In total , 115 moderately hypercholesterolaemic , non-statin-treated adults ( 25 - 70 years ) were r and omly assigned to an experimental diet group ( Ex-diet group ) or control diet group ( C-diet group ) for 8 weeks with commercially available food items with different fatty acid composition ( replacing SFA with mostly n-6 PUFA ) . In the Ex-diet group , serum total cholesterol ( P<0·001 ) and LDL-cholesterol ( P<0·001 ) were reduced after 8 weeks , compared with the C-diet group . The difference in change between the two groups at the end of the study was -9 and -11 % in total cholesterol and LDL-cholesterol , respectively . No difference in change in plasma levels of inflammatory markers ( high-sensitive C-reactive protein , IL-6 , soluble TNF receptor 1 and interferon-γ ) was observed between the groups . In conclusion , exchanging a few regularly consumed food items with improved fat quality reduces total cholesterol , with no negative effect on levels of inflammatory markers . This shows that an exchange of a few commercially available food items was easy and manageable and led to clinical ly relevant cholesterol reduction , potentially affecting future CVD risk The effects on blood lipids and blood pressure of a diet corresponding to present Nordic Nutrition Recommendations , i.e. less than 30 % of energy from fat and with a fibre content exceeding 3 g/MJ , were studied in 18 men and 12 women ( mean age , 24 years ) under strict dietary control over 8 months .  Blood sampling , blood pressure and body weight measurement were performed at four occasions on their habitual diet and once a month during the intervention period . An age-matched control group ( 17 men , 8 women ) was followed with monthly measurements parallel to the intervention group . The habitual diets , assessed by 7-day records , showed an average fat content corresponding to 36 % of energy . Initial levels of total cholesterol and HDL cholesterol ( X + /- SD ) were 4.21 + /- 0.61 and 1.23 + /- 0.23 mmol/l for the men in the intervention group ; 4.35 + /- 0.79 and 1.21 + /- 0.26 mmol/l for the male controls ; 4.61 + /- 0.59 and 1.46 + /- 0.31 mmol/l for the women in the intervention group and 4.48 + /- 0.64 and 1.48 + /- 0.29 mmol/l for the female controls . Significantly decreased levels of total cholesterol and HDL cholesterol throughout the experimental period were seen for both sexes in the intervention group . Total cholesterol fell 0.49 mmol/l ( 95 % CI : 0.41 - 0.56 ) in the male subjects and 0.49 mmol/l ( 95 % CI : 0.39 - 0.59 ) in the female subjects . The fall in HDL cholesterol was 0.16 mmol/l ( 95 % C : 0.13 - 0.18 ) and 0.18 mmol/l ( 95 % CI : 0.12 - 0.23 ) , respectively . Total cholesterol changes were independent of initial values . All subjects were normotensive at the start of the study with an average blood pressure of 122/68 mmHg for men and 112/68 mmHg for the women . Systolic blood pressure dropped gradually and significantly in the male subjects of the intervention group . A minimum of 6 mmHg below initial values was noted after six months of dietary intervention . No significant changes in dietary intake and blood lipids were observed in the control group . Thus , changes of present dietary habits of young healthy Danish subjects to an intake in accordance with the Nordic Nutrition Recommendations 1989 will favourably affect suggested risk factors for disease BACKGROUND Experimental studies in animals and cross-sectional studies in humans have suggested that low serum magnesium levels might lead to type 2 diabetes ; however , this association has not been examined prospect ively . METHODS We assessed the risk for type 2 diabetes associated with low serum magnesium level and low dietary magnesium intake in a cohort of nondiabetic middle-aged adults ( N = 12,128 ) from the Atherosclerosis Risk in Communities Study during 6 years of follow-up .  Fasting serum magnesium level  , categorized into 6 levels , and  dietary magnesium intake  , categorized into quartiles , were measured at the baseline examination . Incident type 2 diabetes was defined by self-report of physician diagnosis , use of diabetic medication , fasting glucose level of at least 7.0 mmol/L ( 126 mg/dL ) , or nonfasting glucose level of at least 11.1 mmol/L ( 200 mg/dL ) . RESULTS Among white participants , a grade d inverse relationship between serum magnesium levels and incident type 2 diabetes was observed . From the highest to the lowest serum magnesium levels , there was an approximate 2-fold increase in incidence rate ( 11.1 , 12.2 , 13.6 , 12.8 , 15.8 , and 22.8 per 1000 person-years ; P = .001 ) . This grade d association remained significant after simultaneous adjustment for potential confounders , including diuretic use . Compared with individuals with serum magnesium levels of 0.95 mmol/L ( 1.90 mEq/L ) or greater , the adjusted relative odds of incident type 2 diabetes rose progressively across the following lower magnesium categories : 1.13 ( 95 % CI , 0.79 - 1.61 ) , 1.20 ( 95 % CI , 0.86 - 1.68 ) , 1.11 ( 95 % CI , 0.80 - 1.56 ) , 1.24 ( 95 % CI , 0.86 - 1.78 ) , and 1.76 ( 95 % CI , 1.18 - 2.61 ) ( for trend , P = .01 ) . In contrast , little or no association was observed in black participants . No association was detected between  dietary magnesium intake  and the risk for incident type 2 diabetes in black or white participants . CONCLUSIONS Among white participants , low serum magnesium level is a strong , independent predictor of incident type 2 diabetes . That low dietary magnesium intake does not confer risk for type 2 diabetes implies that compartmentalization and renal h and ling of magnesium may be important in the relationship between low serum magnesium levels and the risk for type 2 diabetes BACKGROUND The effect of increasing the intake of dietary fiber on glycemic control in patients with type 2 diabetes mellitus is controversial . METHODS In a r and omized , crossover study , we assigned 13 patients with type 2 diabetes mellitus to follow two diets , each for six weeks : a diet containing moderate amounts of fiber ( total , 24 g ; 8 g of soluble fiber and 16 g of insoluble fiber ) , as recommended by the American Diabetes Association ( ADA ) , and a high-fiber diet ( total , 50 g ; 25 g of soluble fiber and 25 g of insoluble fiber ) , containing foods not fortified with fiber ( unfortified foods ) . Both diets , prepared in a research kitchen , had the same macronutrient and energy content . We compared the effects of the two diets on glycemic control and plasma lipid concentrations . RESULTS Compliance with the diets was excellent . During the sixth week , the high-fiber diet , as compared with the the sixth week of the ADA diet , mean daily prepr and ial plasma glucose concentrations were 13 mg per deciliter [ 0.7 mmol per liter ] lower ( 95 percent confidence interval , 1 to 24 mg per deciliter [ 0.1 to 1.3 mmol per liter ] ; P=0.04 ) and mean median difference , daily urinary glucose excretion 1.3 g ( 0.23 ; 95 percent confidence interval , 0.03 to 1.83 g ; P= 0.008 ) . The high-fiber diet also lowered the area under the curve for 24-hour plasma glucose and insulin concentrations , which were measured every two hours , by 10 percent ( P=0.02 ) and 12 percent ( P=0.05 ) , respectively . The high-fiber diet reduced plasma total cholesterol concentrations by 6.7 percent ( P=0.02 ) , triglyceride concentrations by 10.2 percent ( P=0.02 ) , and very-low-density lipoprotein cholesterol concentrations by 12.5 percent ( P=0.01 ) . CONCLUSIONS A high intake of dietary fiber , particularly of the soluble type , above the level recommended by the ADA , improves glycemic control , decreases hyperinsulinemia , and lowers plasma lipid concentrations in patients with type 2 diabetes Background / Objectives : Short-term studies have suggested beneficial effects of a Palaeolithic-type diet ( PD ) on body weight and metabolic balance . We now report the long-term effects of a PD on anthropometric measurements and metabolic balance in obese postmenopausal women , in comparison with a diet according to the Nordic Nutrition Recommendations (NNR).Subjects/ Methods : Seventy obese postmenopausal women ( mean age 60 years , body mass index 33 kg/m2 ) were assigned to an ad libitum PD or NNR diet in a 2-year r and omized controlled trial . The primary outcome was change in fat mass as measured by dual-energy X-ray absorptiometry . Results : Both groups significantly decreased total fat mass at 6 months ( −6.5 and −2.6 kg ) and 24 months ( −4.6 and −2.9 kg ) , with a more pronounced fat loss in the PD group at 6 months ( P<0.001 ) but not at 24 months ( P=0.095 ) . Waist circumference and sagittal diameter also decreased in both the groups , with a more pronounced decrease in the PD group at 6 months ( −11.1 vs−5.8 cm , P=0.001 and −3.7 vs−2.0 cm , P<0.001 , respectively ) . Triglyceride levels decreased significantly more at 6 and 24 months in the PD group than in the NNR group ( P<0.001 and P=0.004 ) . Nitrogen excretion did not differ between the groups . Conclusions : A PD has greater beneficial effects vs an NNR diet regarding fat mass , abdominal obesity and triglyceride levels in obese postmenopausal women ; effects not sustained for anthropometric measurements at 24 months . Adherence to protein intake was poor in  the PD group . The long-term consequences of these changes remain to be studied We served a low-fat ( 28 % of energy ) high-fibre ( 3.3 g/MJ ) diet according to Nordic Nutrition Recommendations ( REC diet ) , and a high-fat diet ( 39 % of energy ) corresponding to the average Danish diet ( DANE diet ) to 21 healthy middle-aged individuals in a two times two weeks cross-over study . The REC diet result ed in lower serum concentrations of low density lipoprotein ( LDL ) cholesterol ( medians : 2.77 vs 3.04 mmol/l , p < 0.001 ) , and high-density lipoprotein ( HDL ) cholesterol ( 1.08 vs 1.24 mmol/l , p < 0.001 ) , and higher fasting triglycerides ( 1.11 vs 0.86 mmol/l , p = 0.04 ) than the DANE diet . Furthermore , the REC diet lowered plasma factor VII coagulant activity ( FVIIc ) ( 88 vs 96 % , p = 0.002 ) and raised plasma fibrinolytic activity . Our observations indicate that a low-fat high-fibre diet may not only reduce the atherogenic , but also the thrombogenic tendency of an individual compared with a diet corresponding to the average Danish diet Introduction : Danish children consume too much sugar and not enough whole grain , fish , fruit , and vegetables . The Nordic region is rich in such foods with a strong health-promoting potential . We lack r and omised controlled trials that investigate the developmental and health impact of serving school meals based on Nordic foods . Aim : This paper describes the rationale , design , study population , and potential implication s of the Optimal well-being , development and health for Danish children through a healthy New Nordic Diet ( OPUS ) School Meal Study . Methods : In a cluster-r and omised cross-over design , 1021 children from 3rd and 4th grade s ( 8–11 years old ) at nine Danish municipal schools were invited to participate . Classes were assigned to two 3-month periods with free school meals based on the New Nordic Diet ( NND ) or their usual packed lunch ( control ) .  Dietary intake , nutrient status , physical activity , cardiorespiratory fitness , sleep , growth , body composition , early metabolic and cardiovascular risk markers , illness , absence from school , wellbeing , cognitive function , social and cultural features , food acceptance , waste , and cost were assessed . Results : In total , 834 children ( 82 % of those invited ) participated . Although their parents were slightly better educated than the background population , children from various socioeconomic background s were included . The proportion of overweight and obese children ( 14 % ) resembled that of earlier examinations of Danish school children . Drop out was 8.3 % . Conclusions : A high inclusion rate and low drop out rate was achieved . This study will be the first to determine whether school meals based on the NND improve children ’s diet , health , growth , cognitive performance , and early disease risk markers OBJECTIVE the aim of this study was to investigate the effects of a healthy Nordic diet ( ND ) on cardiovascular risk factors . DESIGN AND SUBJECTS in a r and omized controlled trial ( NORDIET ) conducted in Sweden , 88 mildly hypercholesterolaemic subjects were r and omly assigned to an ad libitum ND or control diet ( subjects ' usual Western diet ) for 6 weeks . Participants in the ND group were provided with all meals and foods . Primary outcome measurements were low-density lipoprotein ( LDL ) cholesterol , and secondary outcomes were blood pressure ( BP ) and insulin sensitivity ( fasting insulin and homeostatic model assessment -insulin resistance ) . The ND was rich in high-fibre plant foods , fruits , berries , vegetables , whole grains , rapeseed oil , nuts , fish and low-fat milk products , but low in salt , added sugars and saturated fats . RESULTS the ND contained 27 % , 52 % , 19 % and 2 % of energy from fat , carbohydrate , protein and alcohol , respectively . In total , 86 of 88 subjects r and omly assigned to diet completed the study . Compared with controls , there was a decrease in plasma cholesterol ( -16 % , P < 0.001 ) , LDL cholesterol ( -21 % , P < 0.001 ) , high-density lipoprotein ( HDL ) cholesterol ( -5 % , P < 0.01 ) , LDL/HDL ( -14 % , P < 0.01 ) and apolipoprotein (apo)B/apoA1 ( -1 % , P < 0.05 ) in the ND group . The ND reduced insulin ( -9 % , P = 0.01 ) and systolic BP by -6.6 ± 13.2 mmHg ( -5 % , P < 0.05 ) compared with the control diet . Despite the ad libitum nature of the ND , body weight decreased after 6 weeks in the ND compared with the control group ( -4 % , P < 0.001 ) . After adjustment for weight change , the significant differences between groups remained for blood lipids , but not for insulin sensitivity or BP . There were no significant differences in diastolic BP or triglyceride or glucose concentrations . CONCLUSIONS a healthy ND improves blood lipid profile and insulin sensitivity and lowers blood pressure at clinical ly relevant levels in hypercholesterolaemic subjects Background / Objectives : Our objective was to investigate changes in liver fat and insulin sensitivity during a 2-year diet intervention . An ad libitum Paleolithic diet ( PD ) was compared with a conventional low-fat diet (LFD).Subjects/ Methods : Seventy healthy , obese , postmenopausal women were r and omized to either a PD or a conventional LFD . Diet intakes were ad libitum . Liver fat was measured with proton magnetic resonance spectroscopy . Insulin sensitivity was evaluated with oral glucose tolerance tests and calculated as homeostasis model assessment -insulin resistance (HOMA-IR)/liver insulin resistance ( Liver IR ) index for hepatic insulin sensitivity and oral glucose insulin sensitivity (OGIS)/Matsuda for peripheral insulin sensitivity . All measurements were performed at 0 , 6 and 24 months . Forty-one women completed the examinations for liver fat and were included . Results : Liver fat decreased after 6 months by 64 % ( 95 % confidence interval : 54–74 % ) in the PD group and by 43 % ( 27–59 % ) in the LFD group ( P<0.01 for difference between groups ) . After 24 months , liver fat decreased 50 % ( 25–75 % ) in the PD group and 49 % ( 27–71 % ) in the LFD group . Weight reduction between baseline and 6 months was correlated to liver fat improvement in the LFD group ( rs=0.66 , P<0.01 ) but not in the PD group ( rs=0.07 , P=0.75 ) . Hepatic insulin sensitivity improved during the first 6 months in the PD group ( P<0.001 for Liver IR index and HOMA-IR ) , but deteriorated between 6 and 24 months without association with liver fat changes . Conclusions : A PD with ad libitum intake had a significant and persistent effect on liver fat and differed significantly from a conventional LFD at 6 months . This difference may be due to food quality , for example , a higher content of mono- and polyunsaturated fatty acids in the PD . Changes in liver fat did not associate with alterations in insulin sensitivity OBJECTIVE Abdominal fat accumulation after menopause is associated with low- grade inflammation and increased risk of metabolic disorders . Effective long-term lifestyle treatment is therefore needed . METHODS Seventy healthy postmenopausal women ( age 60 ± 5.6 years ) with BMI 32.5 ± 5.5 were r and omized  to a Paleolithic-type diet ( PD ) or a prudent control diet ( CD ) for 24 months . Blood sample s and fat biopsies  were collected at baseline , 6 months , and 24 months to analyze inflammation-related parameters . RESULTS And roid fat decreased significantly more in the PD group ( P = 0.009 ) during the first 6 months with weight maintenance at 24 months in both groups . Long-term significant effects ( P < 0.001 ) on adipose gene expression were found for toll-like receptor 4 ( decreased at 24 months ) and macrophage migration inhibitory factor ( increased at 24 months ) in both groups . Serum interleukin 6 ( IL-6 ) and tumor necrosis factor α levels were decreased at 24 months in both groups ( P < 0.001 ) with a significant diet-by-time interaction for serum IL-6 ( P = 0.022 ) . High-sensitivity C-reactive protein was decreased in the PD group at 24 months ( P = 0.001 ) . CONCLUSIONS A reduction of abdominal obesity in postmenopausal women is linked to specific changes in inflammation-related adipose gene expression Biomarkers of dietary intake can be important tools in nutrition research . Our aim was to assess whether plasma alkylresorcinol ( AR ) and β-carotene concentrations could be used as dietary biomarkers for whole-grain , fruits and vegetables in a healthy Nordic diet ( ND ) . Participants ( n = 166 ) , 30 - 65 y with a body mass index of 27 - 40 kg/m(2 ) and two more features of metabolic syndrome ( International Diabetes Federation definition , slightly modified ) , were recruited through six centers in the Nordic countries and r and omly assigned to an ND or control diet for 18 or 24 wk , depending on study center . Plasma AR and β-carotene were analyzed and nutrient intake calculated from 4-d food records . Median fiber intake increased in the ND group from 2.5 g/MJ at baseline to 4.1 g/MJ ( P < 0.001 ) at end point ( week 18 or 24 ) , and median ( IQR ) fasting plasma total AR concentration increased from 73 ( 88 ) to 106 ( 108 ) nmol/L , or 45 % , from baseline to end point ( P < 0.001 ) . The AR concentration was significantly higher in the ND group ( P < 0.001 ) than in the control group at end point . β-Carotene intake tended to increase in the ND group ( P = 0.07 ) , but the plasma β-carotene concentration did not change significantly throughout the study and did not differ between the groups at follow-up . In conclusion , an ND result ed in higher dietary fiber intake and increased plasma total AR concentration compared with the control diet , showing that the total AR concentration might be a valid biomarker for an ND in which whole-grain wheat and rye are important components . No significant difference in plasma β-carotene concentrations was observed between the ND and control groups , suggesting that β-carotene may not be a sensitive enough biomarker of the ND
target: This dietary pattern did not significantly affect 2-h post-pr and ial blood glucose and Matsuda index .
  Conclusions Adherence to the ND might improve serum insulin and HOMA-IR levels ; however , this effect was not confirmed for other markers of blood glucose control .
background: Aims Investigations on the possible effect of the Nordic diet ( ND ) on the glycemic control and the risk of diabetes have led to inconsistent results .
  The present study tried to determine the effect of the ND on the markers of blood glucose control using a systematic review and meta- analysis of r and omized controlled clinical trials ( RCTs ) .