British Journal of Nutrition

Full Papers

Dietary Surveys and Nutritional Epidemiology

Adherence to the Baltic Sea diet consumed in the Nordic countries is associated with lower abdominal obesity

Noora Kanervaa1 c1, Niina E. Kaartinena1, Ursula Schwaba2a3, Marjaana Lahti-Koskia4 and Satu Männistöa1

a1 Department of Chronic Disease Prevention, National Institute for Health and Welfare, PO Box 30, FI-00270 Helsinki, Finland

a2 Department of Clinical Nutrition, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, PO Box 1627, 70211 Kuopio, Finland

a3 Institute of Clinical Medicine, Internal Medicine, Kuopio University Hospital, Kuopio, Finland

a4 Finnish Heart Association, PO Box 50, 00621 Helsinki, Finland


Due to differences in food cultures, dietary quality measures, such as the Mediterranean Diet Score, may not be easily adopted by other countries. Recently, the Baltic Sea Diet Pyramid was developed to illustrate healthy choices for the diet consumed in the Nordic countries. We assessed whether the Baltic Sea Diet Score (BSDS) based on the Pyramid is associated with a decreased risk of obesity and abdominal obesity. The population-based cross-sectional study included 4720 Finns (25–74 years) from the National FINRISK 2007 study. Diet was assessed using a validated FFQ. The score included Nordic fruits and berries, vegetables, cereals, ratio of PUFA:SFA and trans-fatty acids, low-fat milk, fish, red and processed meat, total fat (percentage of energy), and alcohol. Height, weight and waist circumference (WC) were measured and BMI values were calculated. In a multivariable model, men in the highest v. lowest BSDS quintile were more likely to have normal WC (OR 0·48, 95 % CI 0·29, 0·80). In women, this association was similar but not significant (OR 0·65, 95 % CI 0·39, 1·09). The association appeared to be stronger in younger age groups (men: OR 0·23, 95 % CI 0·08, 0·62; women: OR 0·17, 95 % CI 0·05, 0·58) compared with older age groups. Nordic cereals and alcohol were found to be the most important BSDS components related to WC. No association was observed between the BSDS and BMI. The present study suggests that combination of Nordic foods, especially cereals and moderate alcohol consumption, is likely to be inversely associated with abdominal obesity.

(Received October 05 2011)

(Revised February 09 2012)

(Accepted March 08 2012)

(Online publication May 10 2012)

Key Words:

  • Abdominal obesity;
  • Baltic Sea diet;
  • Dietary quality;
  • Obesity;
  • Waist circumference


c1 Corresponding author: N. Kanerva, fax +358 20 610 8338, E-mail:


  Abbreviations: BSDS, Baltic Sea Diet Score; DILGOM, Dietary Lifestyle and Genetic Determinants on the Development of Obesity and Metabolic syndrome; EI, energy intake; PA, physical activity; WC, waist circumference